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High-frequency chest wall oscillation in ALS

An exploratory randomized, controlled trial

From the Department of Neurology (D.J.L.), Mt. Sinai School of Medicine, New York, NY; Department of Medicine (N.L.), Johns Hopkins University, Baltimore, MD; Hennepin Faculty Associates ALSA-Certified ALS Center (W.D.), Minneapolis, MN; Department of Neurology (T.H.-P.), Drexel University, Philadelphia, PA; Department of Neurology (D.G.), California Pacific Medical Center, San Francisco, CA; Division of Biostatistics (C.D.), University of Minnesota School of Public Health, Minneapolis, MN; Neurological Institute (H.M.), Columbia University, New York, NY; Hill-Rom, Inc. (B.D.), Minneapolis, MN.

Address correspondence and reprint requests to Dr. Dale J. Lange, Department of Neurology, Mt. Sinai School of Medicine, One Gustave L. Levy Place, Box 1052, New York, NY 10029; e-mail: dale.lange{at}mssm.edu

Objectives: To evaluate changes in respiratory function in patients with ALS after using high-frequency chest wall oscillation (HFCWO).

Methods: This was a 12-week randomized, controlled trial of HFCWO in patients with probable or definite ALS, an Amyotrophic Lateral Sclerosis Functional Rating Scale respiratory subscale score 11 and 5, and forced vital capacity (FVC) 40% predicted.

Results: We enrolled 46 patients (58.0 ± 9.8 years; 21 men, 25 women); 22 used HFCWO and 24 were untreated. Thirty-five completed the trial: 19 used HFCWO and 16 untreated. HFCWO users had less breathlessness (p = 0.021) and coughed more at night (p = 0.048) at 12 weeks compared to baseline. At 12 weeks, HFCWO users reported a decline in breathlessness (p = 0.048); nonusers reported more noise when breathing (p = 0.027). There were no significant differences in FVC change, peak expiratory flow, capnography, oxygen saturation, fatigue, or transitional dyspnea index. When patients with FVC between 40 and 70% predicted were analyzed, FVC showed a significant mean decrease in untreated patients but not in HFCWO patients; HFCWO patients had significantly less increased fatigue and breathlessness. Satisfaction with HFCWO was 79%.

Conclusion: High-frequency chest wall oscillation was well tolerated, considered helpful by a majority of patients, and decreased symptoms of breathlessness. In patients with impaired breathing, high-frequency chest wall oscillation decreased fatigue and showed a trend toward slowing the decline of forced vital capacity.

*See the Appendix for a list of Group members.

Funded by Hill-Rom, Inc., formerly Advanced Respiratory Company, St. Paul, MN.

Disclosure: Honoraria reimbursing travel expenses were paid to all investigators during the planning phase of the study. Mr. Becker is an employee of Hill-Rom, Inc.

Received February 6, 2006.

Accepted in final form May 4, 2006.