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September 25, 2006

High-frequency chest wall oscillation in ALS
An exploratory randomized, controlled trial

September 26, 2006 issue
67 (6) 991-997

Abstract

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.

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References

1.
Simmons Z. Management strategies for patients with amyotrophic lateral sclerosis from diagnosis through death. Neurologist 2005;11:257–270.
2.
Kleopa KA, Sherman M, Neal B, Romano GJ, Heiman-Patterson T. Bipap improves survival and rate of pulmonary function decline in patients with ALS. J Neurol Sci 1999;164:82–88.
3.
Miller RG, Rosenberg JA, Gelinas DF, et al. Practice parameter: the care of the patient with amyotrophic lateral sclerosis (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology: ALS Practice Parameters Task Force. Neurology 1999;52:1311–1323.
4.
Rubin EM, Scantlen GE, Chapman GA, Eldridge M, Menendez R, Wanner A. Effect of chest wall oscillation on mucus clearance: comparison of two vibrators. Pediatr Pulmonol 1989;6:122–126.
5.
Harf A, Zidulka A, Chang HK. Nitrogen washout during tidal breathing with superimposed high-frequency chest wall oscillation. Am Rev Respir Dis 1985;132:350–353.
6.
Dosman CF, Jones RL. High-frequency chest compression: a summary of the literature. Can Respir J 2005;12:37–41.
7.
Brooks BR, Miller RG, Swash M, Munsat TL. El Escorial revisited: revised criteria for the diagnosis of amyotrophic lateral sclerosis. Amyotroph Lateral Scler Other Motor Neuron Disord 2000;1:293–299.
8.
Aboussouan LS, Khan SU, Banerjee M, Arroliga AC, Mitsumoto H. Objective measures of the efficacy of noninvasive positive-pressure ventilation in amyotrophic lateral sclerosis. Muscle Nerve 2001;24:403–409.
9.
Drory VE, Gross D. No effect of creatine on respiratory distress in amyotrophic lateral sclerosis. Amyotroph Lateral Scler Other Motor Neuron Disord 2002;3:43–46.
10.
Miscio G, Guastamacchia G, Priano L, Baudo S, Mauro A. Are the neurophysiological techniques useful for the diagnosis of diaphragmatic impairment in multiple sclerosis (MS)? Clin Neurophysiol 2003;114:147–153.
11.
Paul J, Ling E, Hajgato J, McDonald L. Both the OxyArm and Capnoxygen mask provide clinically useful capnographic monitoring capability in volunteers. Can J Anaesth 2003;50:137–142.
12.
Kaye KS, Stalam M, Shershen WE, Kaye D. Utility of pulse oximetry in diagnosing pneumonia in nursing home residents. Am J Med Sci 2002;324:237–242.
13.
Mahler DA, Horowitz MB. Clinical evaluation of exertional dyspnea. Clin Chest Med 1994;15:259–269.
14.
Krupp LB, LaRocca NG, Muir-Nash J, Steinberg AD. The Fatigue Severity Scale. Application to patients with multiple sclerosis and systemic lupus erythematosus. Arch Neurol 1989;46:1121–1123.
15.
Cedarbaum JM, Stambler N, Malta E, et al. The ALSFRS-R: a revised ALS functional rating scale that incorporates assessments of respiratory function. BDNF ALS Study Group (Phase III). J Neurol Sci 1999;169:13–21.
16.
Jenkinson C, Fitzpatrick R. Reduced item set for the Amyotrophic Lateral Sclerosis Assessment Questionnaire: development and validation of the ALSAQ-5. J Neurol Neurosurg Psychiatry 2001;70:70–73.
17.
Mahler DA, Weinberg DH, Wells CK, Feinstein AR. The measurement of dyspnea. Contents, interobserver agreement, and physiologic correlates of two new clinical indexes. Chest 1984;85:751–758.
18.
Mahler DA, Faryniarz K, Tomlinson D, et al. Impact of dyspnea and physiologic function on general health status in patients with chronic obstructive pulmonary disease. Chest 1992;102:395–401.
19.
Kluft J, Beker L, Castagnino M, Gaiser J, Chaney H, Fink RJ. A comparison of bronchial drainage treatments in cystic fibrosis. Pediatr Pulmonol 1996;22:271–274.
20.
Scherer TA, Barandun J, Martinez E, Wanner A, Rubin EM. Effect of high-frequency oral airway and chest wall oscillation and conventional chest physical therapy on expectoration in patients with stable cystic fibrosis. Chest 1998;113:1019–1027.
21.
Giarraffa P, Berger KI, Chaikin AA, Axelrod FB, Davey C, Becker B. Assessing efficacy of high-frequency chest wall oscillation in patients with familial dysautonomia. Chest 2005;128:3377–3381.
22.
Al Saady NM, Fernando SS, Petros AJ, Cummin AR, Sidhu VS, Bennett ED. External high frequency oscillation in normal subjects and in patients with acute respiratory failure. Anaesthesia 1995;50:1031–1035.
23.
Darbee JC, Kanga JF, Ohtake PJ. Physiologic evidence for high-frequency chest wall oscillation and positive expiratory pressure breathing in hospitalized subjects with cystic fibrosis. Phys Ther 2005;85:1278–1289.
24.
Lechtzin N, Lange DJ, Davey C, et al. The performance of an instrument to measure change in dyspnea in patients with amyotrophic lateral sclerosis. Amyotroph Lateral Scler Other Motor Neuron Disord 2006;6(suppl 1):62.

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Published In

Neurology®
Volume 67Number 6September 26, 2006
Pages: 991-997
PubMed: 17000967

Publication History

Published online: September 25, 2006
Published in print: September 26, 2006

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Authors

Affiliations & Disclosures

D. J. Lange, MD
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.
N. Lechtzin, MD
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.
C. Davey, MS
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.
W. David, MD, PhD
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.
T. Heiman-Patterson, MD
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.
D. Gelinas, MD
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.
B. Becker, MEd, RRT
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.
H. Mitsumoto, MD
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.
the HFCWO Study Group
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.

Notes

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: [email protected]

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