Intra Versus Extra-thoracic Oscillations in Chronic Obstructive Pulmonary Disease


Chronic Obstructive Pulmonary Disease (COPD) is the fourth-leading cause of death. It is a progressive illness that requires life-long treatment.Promoting airway clearance (AC) using mucolytics together with airway clearance techniques (ACTs) form the basis for pulmonary therapy in COPD care.Therefore, new airway clearance modalities are required to decrease the detrimental effects of accumulated secretions in COPD.

One of the devices used in AC is the high frequency chest wall oscillation (The Vest). HFCWO involves the use of an inflatable vest/jacket that covers the chest and is attached to an air pulse-generating compressor which rapidly inflates and deflates the vest, producing oscillations to the chest wall of 5-25 Hz.

Another new airway clearance modality is oscillating positive expiratory pressure(Quake) which combines PEP therapy with high frequency oscillations.

Study Type

  • Study Type: Interventional
  • Study Design
    • Allocation: Randomized
    • Intervention Model: Parallel Assignment
    • Primary Purpose: Treatment
    • Masking: Single (Investigator)
  • Study Primary Completion Date: May 1, 2019

Detailed Description

The present study aimed to evaluate the effectiveness of the extra thoracic oscillations via high frequency chest wall oscillation vest (HFCWO) versus the intra thoracic oscillations via oscillatory positive expiratory pressure (OPEP) Quake device in COPD Group A: consists of 30 patients will be treated by high frequency chest wall oscillation vest along with their prescribed medical treatment. This program will be performed 4 times per week for 6 successive weeks.

Group B: consists of 30 patients will be treated by vibratory PEP (The Quake) along with their prescribed medical treatment. This program will be performed 4 times per week for 6 successive weeks.


  • Device: High frequency extra thoracic oscillations vest
    • Oscillations applied extra thoracic through vest device aiming for airway clearance
  • Device: Intrathoracic oscillatory quake
    • Oscillation introduced intrathoracic through quake device through placing quake in mouth and ordering patient to breathing to move secretions

Arms, Groups and Cohorts

  • Experimental: Vest arm
    • high frequency chest wall oscillation vest performed 4 times per week for 6 successive weeks for 30 patients
  • Experimental: Quake arm
    • Vibratory positive expiratory pressure quake performed 4 times per week for 6 successive weeks for 30 patients

Clinical Trial Outcome Measures

Primary Measures

  • Pulmonary function test (spirometry)
    • Time Frame: Before and 6 weeks
    • it measure ventilatory functions. Then the patients sat comfortably and upright while putting the nose clip and relax. The patient was asked to inhale as deeply as possible, hold the breath, and then inserted the mouthpiece carefully into the mouth. The patient held the mouthpiece tightly between the lips, and kept tongue down. The patient was asked to exhale for as long as possible and blow for at least 6 seconds.

Secondary Measures

  • impulse oscillometry
    • Time Frame: before and 6 weeks
    • The patient was in sitting position, Legs kept uncrossed The patient firmly supported his cheeks during measurement. The mouthpiece was at a comfortable height so that the neck is slightly extended and ensure that there is a tight seal between the mouthpiece and lips to prevent air leak. The patient was instructed to perform normal tidal breathing in a relaxed state during the procedure. The recording was performed for at least 30-45 s. During this period, around 120-150 sound impulses were pushed into the lungs from which the mean reactance and resistance values were determined at frequencies from 5 to 20 Hz.

Participating in This Clinical Trial

Inclusion Criteria

  • • All patients were diagnosed by chest physician based on the modified criteria defined in the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines 2017.
  • All patients were diagnosed as COPD for at least two years.
  • All Patients must use their prescribed medications.

Exclusion Criteria

  • All patients that had one of the following were excluded from the study. History of osteoporosis, significant gastro-esophageal reflux, hiatus hernia. Recent acute cardiac event (6 weeks) or congestive cardiac failure. Any significant musculoskeletal disorders. Presence of active hemoptysis Presence of malignant disease

Gender Eligibility: Male

Minimum Age: 45 Years

Maximum Age: 72 Years

Are Healthy Volunteers Accepted: No

Investigator Details

  • Lead Sponsor
    • Cairo University
  • Provider of Information About this Clinical Study
    • Principal Investigator: Alaa Mohamed El-Moatasem Mohamed, Principal investigator – Cairo University
  • Overall Official(s)
    • Nagwa M Badr, Professor, Study Chair, Professor physical therapy at Cairo university
  • Overall Contact(s)
    • Alaa M Elmotasm, ass Lecturer, 0201006625054,

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