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Airway Clearance Vests

The Basics of High-Frequency Chest Wall Oscillation (HFCWO)

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Updated November 24, 2008

Many people with cystic fibrosis (CF) and other medical conditions use high-frequency chest wall oscillation (HFCWO) vests as part of their daily airway clearance routine. If you are considering using a therapy vest, you undoubtedly have some questions that you’ll need answered before you can decide if HFCWO is right for you or your child. Here are the answers to some of the most common questions to get you started.

What HFCWO Vests Look Like

HFCWO vests look similar to water-sport life jackets. They are made out of soft, flexible material that is similar to the material used for blood pressure cuffs. The vest has one or two large, flexible plastic hoses attached to it that connect to a small machine.

There are two brands of HFCWO vests approved by the FDA as airway clearance devices, and each one offers a few styles:

How HFCWO Vests Work

The goals of HFCWO treatment are the same as with any other airway clearance technique -- to break up mucus and help bring it to the upper airways, where it can be coughed out or removed by suction. The machine connected to the vest is an air compressor that delivers bursts of air to rapidly inflate and deflate the vest about 25 times per second. This creates gentle pressure and vibration on the chest, which does three things:

  1. Breaks up mucus, making it thinner
  2. Creates “mini coughs” in the lungs, which help push the mucus out
  3. Makes the cilia move faster, helping them carry the loosened mucus to the upper airways

Who Can Use HFCWO Vests?

There is no minimum age requirement for HFCWO therapy. Generally, once a child’s chest measurement is big enough for the vest to fit properly, he can begin using the vest. However, most insurance companies require certain criteria to be met before they agree to pay for the vest. For example, some insurers may want documentation of frequent respiratory infections, or evidence that other airway clearance techniques have been attempted with limited or no success.

Advantages and Disadvantages of HFCWO Vest Therapy

For some, the vest offers a great alternative or addition to manual chest physiotherapy (CPT), but it’s not the best option for everyone. Studies have shown that the vest is equally as effective as other airway clearance methods, but not necessarily more effective. The decision to use HFCWO therapy or not is a choice based on personal preference and physician recommendations (see chart below).

How and Where to Get a HFCWO Vest

HFCWO vests are only available by prescription. If you are considering using the vest, talk to your doctor or CF treatment center team.

Source:
Marks, J.H. “Airway Clearance Devices in Cystic Fibrosis”. Paediatric Respiratory Reviews. 2007; 8:17–23. 2008 November 21.

AdvantagesDisadvantages
Treatment can be done without help.Expense - the vest costs between $15,000 and $20,000, and is not always covered by insurance.
Does not require any skill, so every treatment will be done correctly.Requires access to electricity.
Freedom to do other things during treatment, because no special position or breathing techniques are required.Must bring equipment with you when traveling. The compressor weighs between 15 and 30 pounds, depending on the model.
Treats all lobes of the lung at once, so treatment time is shorter than manual CPT.
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