Low Incidence of High-Frequency Chest Wall Oscillation in Bronchiectasis Registry Data Despite Indications and...

Airway clearance techniques (ACTs) are required in international bronchiectasis (BE) management guidelines, and high-frequency chest wall oscillation (HFCWO) is the only ACT with a Centers for Medicare and Medicaid Services (CMS) reimbursement guideline.

We aimed to compare patient demographics and clinical characteristics between BE patients using HFCWO to BE patients not using HFCWO.

Bronchiectasis and Nontuberculous Mycobacteria Research Registry (2008–2025) data were retrospectively analyzed. Patients were grouped by baseline HFCWO use and nonusers were further stratified by selected CMS eligibility criteria (productive cough or more than 2 exacerbations per year) and subsequent HFCWO utilization.

Of 5673 patients (median age 69 years), 518 used HFCWO and 5155 did not. HFCWO users had higher rates of asthma (31.7% versus 25.3%, P=0.002), gastroesophageal reflux disease (48.5% versus 41.9%, P=0.004), primary ciliary dyskinesia (5.8% versus 2.1%, P<0.001), allergic bronchopulmonary aspergillosis (3.3% versus 1.7%, P=0.013), and nontuberculous mycobacteria (20.1% versus 15.7%, P=0.011). Symptoms more common in HFCWO users included dyspnea (72.1% versus 38.5%), fatigue (61.5% versus 46.8%), cough (90.9% versus 76.6%,), and hemoptysis (27.1% versus 19.8%) (all P<0.001). The median modified Bronchiectasis Severity Index score was higher in HFCWO users (8 versus 7, P<0.001), and HFCWO users more frequently received antibiotics, bronchodilators, hypertonic saline, and inhaled and oral corticosteroids, indicating greater disease burden. Notably, 58% (2703/4679) of non-HFCWO users appeared to meet selected CMS symptom/exacerbation criteria and their characteristics resembled HFCWO users.

These findings suggest areas to explore to standardize BE management and motivate clearer treatment guidelines to optimize patient health outcomes.