Active Cycle of Breathing Technique Versus Chest Wall Oscillations on Sputum Clearance in Chronic Obstructive Pulmonary Patients
DOI:
https://doi.org/10.61919/jhrr.v6i1.1938Keywords:
Chronic obstructive pulmonary disease; Active cycle of breathing technique; High-frequency chest wall oscillation; Airway clearance; BODE index.Abstract
Background: Chronic obstructive pulmonary disease (COPD) is frequently complicated by mucus retention and ineffective expectoration, contributing to dyspnea and reduced functional capacity, for which airway clearance interventions are commonly prescribed. Objective: To compare the effects of active cycle of breathing technique (ACBT) versus high-frequency chest wall oscillation (HFCWO) on clinically relevant outcomes in adults with advanced COPD. Methods: A randomized clinical trial was conducted at DHQ Hospital Narowal. Adults with stage 3–4 COPD were enrolled by consecutive sampling and randomized to ACBT plus routine chest physiotherapy or HFCWO via vest system. Interventions were delivered for 4 weeks (12 sessions; 3 sessions/week). Outcomes included FEV1% predicted, 6-minute walk distance (6MWD), modified Medical Research Council dyspnea scale (mMRC), and BMI as components aligned with the BODE index framework. Results: Thirty-eight participants were analyzed (n=19/group). At week 4, HFCWO demonstrated higher FEV1% predicted than ACBT (69.79 ± 12.73 vs 55.89 ± 9.30; mean difference 13.90, 95% CI 6.54 to 21.26; p=0.000) and greater 6MWD (418.47 ± 108.25 vs 355.47 ± 45.01; mean difference 63.00 m, 95% CI 7.50 to 118.50; p=0.025), while mMRC and BMI did not differ significantly between groups. Conclusion: Over 4 weeks, HFCWO yielded larger advantages than ACBT for airflow and walking capacity; however, baseline imbalances and dyspnea-scale inconsistencies require correction and prespecified primary-endpoint analysis for definitive inference.
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References
Quissesa A, Juhdeliena J, Gultom ECV. High-frequency chest wall oscillation: airway clearance management for obstructive pulmonary disease patients. Nurs Curr J Keperawatan. 2021;9(2):116-127.
Jaiswal KK, Das AK. Effectiveness of Acapella, Flutter and active cycle of breathing technique on lung function in COPD patients: a comparative study. Indian J Physiother Occup Ther. 2019;13:71.
Irum N, Afzal S, Ali M, Iqbal A, Mureed S, Javed MF. Comparative effects of active cycle of breathing technique and high frequency chest wall oscillations in chronic obstructive pulmonary disease patients [Internet]. [cited 2026 Mar 3].
Nicolini A, Grecchi B, Ferrari-Bravo M, Barlascini C. Safety and effectiveness of the high-frequency chest wall oscillation vs intrapulmonary percussive ventilation in patients with severe COPD. Int J Chron Obstruct Pulmon Dis. 2018;13:617-625. doi:10.2147/COPD.S145440
Shen M, Li Y, Ding X, Xu L, Li F, Lin H. Effect of active cycle of breathing techniques in patients with chronic obstructive pulmonary disease: a systematic review of intervention. Eur J Phys Rehabil Med. 2020;56(5):625-632.
Farag TS, Mariam ES. Utility of vest high frequency chest wall oscillation device versus flutter device in acute exacerbation of chronic obstructive pulmonary disease. Int J Res Med Sci. 2018;6(1):1-9.
Daynes E, Greening N, Siddiqui S, Singh S. A randomised controlled trial to investigate the use of high-frequency airway oscillations as training to improve dyspnoea in COPD. ERJ Open Res [Internet]. 2019 [cited 2026 Mar 3];5(3):00064-2019.
Zuriati Z, Surya M. Effectiveness active cycle of breathing technique (ACBT) with pursed lips breathing technique (PLBT) to tripod position in increase oxygen saturation in patients with COPD, West Sumatera. Enfermeria Clin. 2020;30:164-167.
Theresa DV, Jyothi S, Apparao P, Swamy CG. Effectiveness of active cycle of breathing technique and slow expiration with glottis opened in lateral posture (ELTGOL) on quality of life and functional capacity in subjects with bronchiectasis
Singh T, Kumar N, Sharma N, Patra A. Effectiveness of active cycle of breathing technique along with postural drainage versus autogenic drainage in patients with chronic bronchitis. Physiother Occup Ther. 2019;12(1):12-18.
Westerdahl E, Osadnik C, Emtner M. Airway clearance techniques for patients with acute exacerbations of chronic obstructive pulmonary disease: physical therapy practice in Sweden. Chron Respir Dis. 2019;16:1479973119855868. doi:10.1177/1479973119855868
Osman LP, Roughton M, Hodson ME, Pryor JA. Short-term comparative study of high frequency chest wall oscillation and European airway clearance techniques in patients with cystic fibrosis. Thorax. 2010;65(3):196-200.
Üzmezoğlu B, Altıay G, Özdemir L, Tuna H, Süt N. The efficacy of Flutter® and active cycle of breathing techniques in patients with bronchiectasis: a prospective, randomized, comparative study. Turk Thorac J. 2018;19(3):103-109.
González-Bellido V, Velaz-Baza V, Blanco-Moncada E, Jimeno Esteo MC, Cuenca-Zaldívar JN, Colombo-Marro A, et al. Immediate effects and safety of high-frequency chest wall compression compared to airway clearance techniques in non-hospitalized infants with acute viral bronchiolitis. Respir Care. 2021;66(3):425-433. doi:10.4187/respcare.08177
Sievert CE, Beaner CA. Incidence of bronchiectasis-related exacerbation rates after high frequency chest wall oscillation (HFCWO) treatment—A longitudinal outcome-based study. Respir Ther. 2018;13(2):31.
de Alvarenga GM, Gamba HR, Hellman LE, Ferrari VG, de Macedo RM. Physiotherapy intervention during level I of pulmonary rehabilitation on chronic obstructive pulmonary disease: a systematic review. Open Respir Med J. 2016;10:12-19.
Urme NA, Alam F, Rahman E. Effectiveness of active cycle of breathing technique (ACBT) for the patients of bronchiectasis: a narrative review study. J Clin Respir Care. 2019;5(2):2-5.
Leemans G, Belmans D, Van Holsbeke C, Becker B, Vissers D, Ides K, et al. The effectiveness of a mobile high-frequency chest wall oscillation (HFCWO) device for airway clearance. Pediatr Pulmonol. 2020;55(8):1984-1992. doi:10.1002/ppul.24784
Lin YP, Tung HH, Wang TJ. Comparative study of high frequency chest wall oscillation and traditional chest physical therapy in intensive care unit patients. J Comp Nurs Res Care. 2017;2(2):115.
Goktalay T, Akdemir SE, Alpaydin AO, Coskun AS, Celik P, Yorgancioglu A. Does high-frequency chest wall oscillation therapy have any impact on the infective exacerbations of chronic obstructive pulmonary disease? A randomized controlled single-blind study. Clin Rehabil. 2013;27(8):710-718. doi:10.1177/0269215513478226
Ntritsos G, Franek J, Belbasis L, Christou MA, Markozannes G, Altman P, et al. Gender-specific estimates of COPD prevalence: a systematic review and meta-analysis. Int J Chron Obstruct Pulmon Dis. 2018;13:1507-1514. doi:10.2147/COPD.S146390
Zisi D, Chryssanthopoulos C, Nanas S, Philippou A. The effectiveness of the active cycle of breathing technique in patients with chronic respiratory diseases: a systematic review. Heart Lung. 2022;53:89-98.
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Copyright (c) 2026 Faiza Anayat, Hamna Nasir, Dania Khan, Anam Shahzadi, Insullah Durrani, Hamaila Iqbal
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