Published: 2017-12-23

Utility of vest high frequency chest wall oscillation device versus flutter device in acute exacerbation of chronic obstructive pulmonary disease

Taghreed S. Farag, Mariam EL-Syed


Background: Objectives to assess the effectiveness of high frequency chest wall oscillation (HFCWO) vest system and Flutter devices in the treatment of patients with AECOPD, and to compare the efficacy of HFCWO vest system versus Flutter devices.

Methods: We conducted an interventional study on 108 out of 129 patients presented with AECOPD, recruited from two-university hospitals. They were classified into three groups, HFCWO group (n=37), Flutter group (n=35), and control group (n=36). The HFCWO group and Flutter group were treated with AECOPD medications in addition to either HFCWO or Flutter physiotherapy, three sessions per week, for four weeks, while control group was treated by medications only. All patients were evaluated before and after treatment by spirometry, ABG, CAT score, and the BODE index.

Results: Post treatment assessment for both HFCWO and Flutter groups demonstrated that most of spirometric indices (FEV1%, FVC%, FEV1/FVC %), oxygenations parameters (PaO2, SaO2 %) and CAT score, were significantly improved (p < 0.05). The level of perceived dyspnea decreased significantly, walking distance during 6-MWT was extended significantly, the BODE index and MMRC scale decreased significantly. While in control group only oxygenations parameters (PaO2, SaO2 %) was mildly improved. No statistical significant difference was found between vest HFCWO and Flutter device in all measured post treatment parameters (p > 0.05).

Conclusions: Both vest HFCWO and Flutter device are highly effective in treatment of patients with AECOPD in terms of improvement in ventilatory function and oxygenation parameters with better exercise tolerance.


Acute Exacerbation of chronic obstructive pulmonary disease, high frequency chest wall oscillation, Flutter device, airway clearance devices

Full Text:



Holland A.E. Physiotherapy management of acute exacerbations of chronic obstructive pulmonary disease. J Physiotherap. 2014;60:181-8.

Kim V, Garfield JL, Grabianowski CL , Krahnke JS, Gaughan JP, Jacobs MR, et al. The effect of chronic sputum production on respiratory symptoms in severe COPD. COPD. 2011;8(2):114-20.

Zakerimoghadam M, Tavasoli K, Nejad AK, Khoshkesht S. The effect of breathing exercises on the fatigue levels of patients with chronic obstructive pulmonary disease. Acta Medica Indonesiana. 2011;43(1):29-33.

Nicolini A, Federica C, Norma L, Sergio L, Maura F, Barlascini C. Effectiveness of treatment with high-frequency chest wall oscillation in patients with bronchiectasis. BMC Pulmonary Medicine. 2013;13(21):2-8.

Hristara-Papadopoulou A, Tsanakas J, Diomou G, Papadopoulou O. Current devices of respiratory physiotherapy. Hippokratia. 2008;12(4):211-20.

Mcllwaine PM, Wong LT, Peacock D, Davidson AG. Long-term comparative trial of positive expiratory pressure versus oscillating positive expiratory pressure (Flutter) physiotherapy in the treatment of cystic fibrosis. J Pediatr. 2001;138:845-9.

Chakravorty I, Chahal K, Austin G. A pilot study of the impact of high-frequency chest wall oscillation in chronic obstructive pulmonary disease patients with mucus hypersecretion. Internat J COPD. 2011;6:693-9.

Dodd JW, Hogg L, Nolan J, Jefford H, Grant A, Lord VM, et al. The COPD assessment test (CAT): response to pulmonary rehabilitation. A multicentre prospective study. Thorax. 2011;66(5):425-9.

Jones PW, Tabberer M, Chen WH. Creating scenarios of the impact of COPD and their relationship to COPD Assessment Test (CAT™) scores. BMC Pulm Med. 2011;11:42.

Ghobadi H, Sadeghieh AS, Kameli A, Sharzad M. L. The Relationship between COPD Assessment Test (CAT) Scores and Severity of Airflow Obstruction in Stable COPD Patients. Tanaffos. 2012;11(2):22-6.

Salma S and Yogitha C. Clinical Correlation of COPD Assessment Test (Cat) Questionnaire with Severity in Acute Exacerbation of Chronic Obstructive Pulmonary Disease: IOSR Journal of Dental and Medical Sciences. 2015;14:12-4.

Miravitlles M, Patricia GS, Alonso FN, María JB, and Jesús M. Course of COPD assessment test (CAT) and clinical COPD questionnaire (CCQ) scores during recovery from exacerbations of chronic obstructive pulmonary disease. Health and Quality of Life Outcomes. 2013;11:147.

Celli BR, Cote CG, Marin JM, Casanova C, Montes de Oca M, Mendez RA, Pinto Plata V, Cabral HJ. The body mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease. N Engl J Med. 2004;350:1005-12.

Launois C, Barbe C, Bertin E, Nardi J, Perotin JM, Dury S, Lebargy F, Deslee G. The modified Medical Research Council scale for the assessment of dyspnea in daily living in obesity: a pilot study. BMC Pulmonary Medicine. 2012;12:61.

Chandra D, Wise RA, Kulkarni HS, Benzo RP, Criner G, Make B, Slivka WA, et al. Optimizing the 6-Min Walk Test as a Measure of Exercise Capacity in COPD. Chest. 2012;142(6):1545-52.

Gold: Global Initiative for Chronic Obstructive Lung Disease. Global Strategy for the Diagnosis, Management and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease. Updated. 2016;9-17.

Uçan ES and Kocabaş A. Turkish thoracic society; guidelines for diagnosis and treatment chronic obstructive pulmonary disease. Turkish Thoracic J 2000:1 (Suppl 2):37-42.

Miller MR, Crapo R, Hankinson J, Brusasco V, Burgos F, Casaburi R, et al. ATS/ERS Task Force. General considerations for lung function testing. Eur Respir J. 2005; 26:153-61 Eur Respir J. 2005;26:153-61.

Celli BR, Macnee W. Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS/ERS position paper. Eur Respir J. 2004;23(6):932-46.

ATS: American Thoracic Society: Guidelines for the Six-Minute Walk Test Am J Respir Crit Care Med. 2002;166:111-7.

Gross N. Chronic Obstructive Pulmonary Disease Outcome Measurements. The Proceedings of the American Thoracic Society. 2005;2:267-71.

Goktalay T, Akdemir SE, Alpaydin AO, Coskun AS, Celik P, Yorgancioglu A. Does high-frequency chest wall oscillation therapy have any impact on the infective exacerbations of chronic obstructive pulmonary disease? A randomized controlled single-blind study. Clinical rehabilitation. 2013;27(8):710-8

Mahajan AK, Diette GB, Hatipoğlu U, Bilderback A, Ridge A, Harris VW, et al. High frequency chest wall oscillation for asthma and chronic obstructive pulmonary disease exacerbations: a randomized sham-controlled clinical trial. Respir Res. 2011;10(12):120.

Gastaldi AC. Flutter Device Review: Effects on Secretion and Pulmonary Function. Journal of Novel Physiotherapies. 2016;6:3.

Bhowmik A, Chahal K, Austin G, Chakravorty I. Improving mucociliary clearance in chronic obstructive pulmonary disease. Respir Med. 2009;103:496-502.

Pryor JA. Physiotherapy for airway clearance in adults. Eur Respir J. 1999;14:1418-24.

Braveman J, Nozzarella M. High-frequency chest compression advanced therapy for obstructive lung disease. Resp Therapy. 2007;2:48-51.

Holland AE, and Button BM. Is there a role for airway clearance techniques in chronic obstructive pulmonary disease. Chron Respir Dis. 2006;3(2):83-91.

Guimarães FS, Moço VJ, Menezes SL, Dias CM, Salles RE, Lopes AJ. Effects of ELTGOL and Flutter VRP1® on the dynamic and static pulmonary volumes and on the secretion clearance of patients with bronchiectasis. Rev Bras Fisioter. 2012;16:108-13.

Sontag MK, Quittner AL, Modi AC, Koenig JM, Giles D, Oermann CM, et al. Lessons learned from a randomized trial of airway secretion clearance techniques in cystic fibrosis. Pediatr Pulmonol. 2010;45:291-300.

Wolkove N, Kamel H, Rotaple M, Baltzan MA. Use of a mucus clearance device enhances the bronchodilator response in patients with stable COPD. Chest. 2002;121:702-7.

Orlik T, Sands D. Long-term evaluation of effectiveness for selected chest physiotherapy methods used in the treatment of cystic fibrosis. Med Wieku Rozwoj. 2001;5:245-57.

Burioka N, Sugimoto Y, Suyama H, Hori S, Chikumi H, Sasaki T. Clinical efficacy of the FLUTTER device for airway mucus clearance in patients with diffuse panbronchiolitis. Respirol. 1998;3:183-6.

Jones A, Tse E, Cheung L, To C, Lo C. Restoration of lung volume using the Flutter VRP1 or breathing exercise. Aust J Physiother. 1997;43:183-9.

Lagerkvist AL, Sten GM, Redfors SB, Lindblad AG, Hjalmarson O. Immediate changes in blood-gas tensions during chest physiotherapy with positive expiratory pressure and oscillating positive expiratory pressure in patients with cystic fibrosis. Respir Care. 2006;51:1154-61.

Bellone A, Lascioli R, Raschi S, Guzzi L, Adone R. Chest physical therapy in patients with acute exacerbation of chronic bronchitis: effectiveness of three methods. Arch Phys Med Rehabil. 2000;81:558-60.

Padman R, Geouque DM, Engelhardt MT. Effects of the Flutter device on pulmonary function studies among pediatric cystic fibrosis patients. Del Med J. 1999;71:13-8.

Van Winden CMQ, Visser A, Hop W, Sterk PJ, Beckers S, de Jongste, JC. Effects of Flutter and PEP mask physiotherapy on symptoms and lung function in children with cystic fibrosis. Eur Respir J. 1998;12:143-7.

Kurzaj M, Wierzejski W, Dor A, Stawska J, Rożek K. The Impact of Specialized Physiotherapy Methods on BODE Index in COPD Patients During Hospitalization. Adv Clin Exp Med. 2013;22(5):721-30.