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The prevalence of alpha-1 antitrypsin deficiency in Ireland
Authors:Tomás P Carroll  Catherine A O’Connor  Olwen Floyd  Joseph McPartlin  Dermot P Kelleher  Geraldine O’Brien  Borislav D Dimitrov  Valerie B Morris  Clifford C Taggart  Noel G McElvaney
Affiliation:1. Department of Medicine, Section of Pulmonary and Critical Care, University of Chicago, 5841 S. Maryland Ave, Chicago, Illinois, 60637, USA
2. Department of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, 1830 E. Monument, 5th Floor, Baltimore, Maryland, 21205, USA
3. Department of Medicine, Mercy Hospital and Medical Center, 2525 S. Michigan Avenue, Chicago, Illinois, 60617, USA
4. Respiratory Institute, Cleveland Clinic, MC A90, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
5. Section of Hospital Medicine, University of Chicago, 5841 S. Maryland Ave, Chicago, Illinois, 60637, USA
6. Department of Medicine, Section of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois at Chicago, 840 S. Wood Street, Chicago, Illinois, 60612, USA
Abstract:

Background

High frequency chest wall oscillation (HFCWO) is used for airway mucus clearance. The objective of this study was to evaluate the use of HFCWO early in the treatment of adults hospitalized for acute asthma or chronic obstructive pulmonary disease (COPD).

Methods

Randomized, multi-center, double-masked phase II clinical trial of active or sham treatment initiated within 24 hours of hospital admission for acute asthma or COPD at four academic medical centers. Patients received active or sham treatment for 15 minutes three times a day for four treatments. Medical management was standardized across groups. The primary outcomes were patient adherence to therapy after four treatments (minutes used/60 minutes prescribed) and satisfaction. Secondary outcomes included change in Borg dyspnea score (≥ 1 unit indicates a clinically significant change), spontaneously expectorated sputum volume, and forced expired volume in 1 second.

Results

Fifty-two participants were randomized to active (n = 25) or sham (n = 27) treatment. Patient adherence was similarly high in both groups (91% vs. 93%; p = 0.70). Patient satisfaction was also similarly high in both groups. After four treatments, a higher proportion of patients in the active treatment group had a clinically significant improvement in dyspnea (70.8% vs. 42.3%, p = 0.04). There were no significant differences in other secondary outcomes.

Conclusions

HFCWO is well tolerated in adults hospitalized for acute asthma or COPD and significantly improves dyspnea. The high levels of patient satisfaction in both treatment groups justify the need for sham controls when evaluating the use of HFCWO on patient-reported outcomes. Additional studies are needed to more fully evaluate the role of HFCWO in improving in-hospital and post-discharge outcomes in this population.

Trial Registration

ClinicalTrials.gov: NCT00181285
Keywords:
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