High Frequency Chest Wall Oscillation (HFCWO) Devices

Lung health is dependent upon effective and consistent airway clearance. When airway clearance is compromised, mucus builds up and pools in the airways creating a breeding ground for bacteria and a high risk of infection.

Certain medical conditions such as chronic bronchitis, bronchiectasis, cystic fibrosis and pneumonia are characterized by an increase in mucus production and poor mucus-clearing ability. For illnesses such as these, doctors usually prescribe a combination of drug treatments, standard chest physiotherapy (CPT), special coughing techniques and positions that promote mucus drainage and one or more airway clearance/cough-assist devices designed to facilitate mucus clearance. If traditional methods fail to bring relief or if the patient continues to suffer from complications such as respiratory infections or breathing problems caused by the inability to clear their mucus, a high frequency chest wall oscillation (HFCWO) device may be prescribed which may provide a more powerful means of airway clearance.

What is HFCWO?

HFCWO technology consists of a wearable vest that surrounds an inflatable air bladder. A hose connects the vest to a programmable air pulse generator. Once the patient dons the vest and turns on the generator, the device applies rapidly repeating positive pressure air pulses to gently oscillate the chest wall.

HFCWO is usually started at low pressures and frequencies and then increased to the prescribed pressure/frequency as per the doctor’s recommendation and the patient’s ability to tolerate the procedure.  Each squeeze of the vest is said to simulate a “mini-cough” which purportedly increases airflow, loosens mucus and increases a patient’s cough-clearing ability.

What Does the Research Say?

Several studies report that HFCWO:[1]

  • Increases airflow in the lungs
  • Mobilizes more secretions than standard CPT
  • Aids in mucus expectoration (coughing up of mucus)
  • Contributes to stabilization or improvement of lung function

Why Choose HFCWO?

Traditional airway clearance therapy involves timely posturing and breathing techniques to be effective. Most cannot be performed independently and involve utilizing a caregiver. Moreover, the efficacy of manual CPT is largely dependent upon caregiver knowledge and the use of proper technique. In contrast, HFCWO:

  • Does not require any special positioning or breathing techniques
  • Can be used by most patients without any help from a caregiver
  • Technology is independent of patient or caregiver knowledge or technique

Which Patient’s Benefit Most from HFCWO?

There are a wide range of diseases and health conditions that cause increased mucus production and ineffective airway clearance. The diseases listed below are among those for which HFCWO has been prescribed and may be reimbursed by insurance providers:[2]

  • Amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease)
  • Bronchiectasis
  • Cerebral palsy
  • Emphysema
  • Chronic bronchitis
  • Cystic fibrosis
  • Multiple sclerosis
  • Muscular dystrophy
  • Disorders of the diaphragm
  • Pneumonia
  • Post-operative lung transplant
  • Post-polio syndrome
  • Primary ciliary dyskinesia
  • Quadriplegia
  • Scoliosis
  • Spinal cord injury
  • Spinal muscular atrophy
  • Tracheomalacia
  • Tracheal stenosis

Which Device Should I Choose?

There are a number of HFCWO devices available. Many are covered by Medicare and private insurance companies. If you’re looking to invest in a HFCWO device, you can compare their features and benefits by visiting the following links:


By Deborah Leader RN, BSN, PHN

[1] A Hristara-Papadopoulou, J Tsanakas, G Diomou, and O Papadopoulou. Current devices of respiratory physiotherapy. Hippokratia. 2008 Oct-Dec; 12(4): 211–220.

[2] Smartvest. “Diseases and conditions that cause impaired airway clearance”. Accessed 10/25/2015.


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