Active Cycle of Breathing Technique Versus High-Frequency Chest Wall Oscillation in Pulmonary Function in Adult Chronic Obstructive Pulmonary Disease Patients: A Randomized Clinical Trial

Khubaib Tahir; Arif Qaisrani; Hifza Imtiaz Ahmed; Mahnoor Baloch

doi:10.61919/jhrr.v6i1.1936

Authors

Khubaib Tahir University of Lahore, Lahore, Pakistan
Arif Qaisrani University of Lahore, Lahore, Pakistan
Hifza Imtiaz Ahmed Riphah International University, Islamabad, Pakistan
Mahnoor Baloch University of Balochistan, Quetta, Pakistan

DOI:

https://doi.org/10.61919/jhrr.v6i1.1936

Keywords:

Chronic obstructive pulmonary disease; active cycle of breathing technique; high-frequency chest wall oscillation; BODE index; pulmonary rehabilitation; airway clearance; forced expiratory volume; six-minute walk test.

Abstract

Background: Chronic obstructive pulmonary disease (COPD) is a progressive, irreversible airflow limitation disorder representing a leading global cause of morbidity and mortality, for which physiotherapy-based airway clearance constitutes a critical management component. Objective: To compare the effects of the active cycle of breathing technique (ACBT) and high-frequency chest wall oscillation (HFCWO) on pulmonary function, exercise capacity, dyspnea severity, and composite BODE index scores in adult patients with stage 3–4 COPD. Methods: A parallel-group randomized clinical trial was conducted at the Pulmonary Department of DHQ Hospital Narowal over six months. Forty-two participants meeting GOLD stage 3–4 criteria were consecutively recruited and randomly allocated to ACBT with routine chest physiotherapy (Group A; n = 21) or HFCWO via pneumatic vest system (Group B; n = 21). Both groups received three sessions per week over four weeks (12 total sessions). Outcome measures included FEV₁ % predicted, six-minute walk distance (6MWD), mMRC dyspnea score, BMI, and composite BODE index, assessed at baseline and week four. Within-group comparisons used paired-samples t-tests and between-group comparisons used independent-samples t-tests (SPSS v25; α = 0.05). Results: HFCWO produced a significantly greater improvement in FEV₁ % predicted compared with ACBT (67.79 ± 12.73% vs 53.89 ± 9.30%; mean difference: 13.90 percentage points; Cohen's d = 1.25; p < 0.001) and in 6MWD (409.47 ± 108.25 m vs 346.47 ± 45.01 m; d = 0.76; p = 0.025). Both groups achieved significant within-group BODE index improvements (ACBT: Δ = +2.32, p = 0.048; HFCWO: Δ = +2.41, p = 0.050). No significant between-group difference was observed for mMRC dyspnea score (p = 0.247) or BMI (p = 0.124). Conclusion: Both ACBT and HFCWO significantly improve functional outcomes in stage 3–4 COPD; however, HFCWO demonstrates superior efficacy in spirometric and exercise capacity domains, supporting its preferential use in advanced obstructive disease where effort-dependent techniques are limited by disease severity.

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