High frequency chest wall oscillation for airway clearance in bronchiectasis

Bronchiectasis is a chronic inflammatory airway disease characterized by impaired mucociliary clearance, persistent mucus retention, recurrent infections, and progressive airway destruction. Airway clearance techniques (ACTs) are central to the management of bronchiectasis, aiming to interrupt the cycle of mucus stasis, infection, and inflammation. High frequency chest wall oscillation (HFCWO) is a noninvasive mechanical ACT increasingly used to facilitate secretion mobilization and improve airway hygiene in patients with bronchiectasis. The objective of the current narrative review is to assess the current evidence regarding the use of HFCWO in patients with bronchiectasis, with emphasis on its physiological rationale, mechanisms of action, clinical applications, effectiveness, practical implementation, safety profile, and limitations. A narrative literature review was conducted using PubMed, Medline, Embase, Scopus, ClinicalTrials.gov, and the Cochrane Library. Relevant studies were analyzed to summarize current evidence regarding the role of HFCWO in bronchiectasis management. The evidence suggests that HFCWO may improve mucus clearance, reduce symptom burden, enhance quality of life, and decrease exacerbation frequency in selected patients with bronchiectasis. HFCWO therapy is particularly useful in patients with chronic productive cough, impaired mucus clearance, frequent exacerbations, or inadequate response to conventional ACT therapies. Practical application requires individual adjustment of treatment frequency, session duration, oscillation frequency, and pressure amplitude according to disease severity and patient tolerance. Despite its benefits, HFCWO use may be limited by high device cost, maintenance requirements, and variable long-term adherence. Reported adverse effects are generally mild and include chest discomfort, dyspnea, transient oxygen desaturation, and fatigue. HFCWO represents a valuable second-line or adjunctive airway clearance therapeutic modality and may be considered in patients with bronchiectasis, particularly those with significant secretion burden and in whom traditional and active self-administered traditional techniques have failed, are poorly tolerated, or when cognitive/physical limitations prevent active patients' participation. Although current evidence supports its physiological and clinical benefits, future high-quality randomized studies are needed to better define patient selection criteria, long-term outcomes, adherence, and comparative effectiveness relative to other airway clearance techniques.