Airway Clearance Vest Systems for Cystic Fibrosis

Many people with cystic fibrosis (CF) and other medical conditions use high-frequency chest wall oscillation (HFCWO) vests, otherwise known as airway clearance systems, as part of their daily airway clearance routine.

If you are considering using a therapy vest, you undoubtedly have some questions that you’ll want to be answered before you decide whether HFCWO is right for you or your child. This article addresses some of the most frequently asked questions (FAQ's) asked about these systems.

What HFCWO Vests Look Like

HFCWO vests look similar to water-sport life jackets. They are made out of soft, flexible material that is similar to the material used for blood pressure cuffs. The vest has one or two large, flexible plastic hoses attached to it that connect to a small machine. Two well-known brands of these vests include:

• The Vest System, manufactured by Hill-Rom
• The SmartVest, manufactured by Electromed

A newer type of vest features built-in individual oscillating mechanical modules that allow for freedom of movement to travel without the restrictive hoses or heavy generators:

• AffloVest - manufactured by International Biophysics Corporation 

How They Work

The goals of HFCWO treatment are the same as with any other airway clearance technique—to break up mucus and help bring it to the upper airways, where it can be coughed out or removed by suction. The machine connected to the vest is an air compressor that delivers bursts of air to rapidly inflate and deflate the vest about 25 times per second. This creates gentle pressure and vibration on the chest, which does three things:

1. Breaks up mucus, making it thinner
2. Creates “mini-coughs” in the lungs, which help push the mucus out
3. Makes the cilia move faster, helping them carry the loosened mucus to the upper airways

Who Can Use HFCWO Vests

There is no minimum age requirement for HFCWO therapy. Generally, once a child’s chest measurement is big enough for the vest to fit properly, he or she can begin using the vest.

Cost

These systems can be expensive or hard to find. New models of the vest can cost between $15,000 and $20,000, and may not always be covered by insurance. For example, most insurance companies require certain criteria to be met before they agree to pay for the vest. For example, some insurers may want documentation of frequent respiratory infections or evidence that other airway clearance techniques have been attempted with limited or no success.

Advantages and Disadvantages

For some, the vest offers a great alternative or addition to manual chest physiotherapy (CPT), but it’s not necessarily the best option for everyone. The decision to use HFCWO therapy or not is a choice based on personal preference and healthcare provider recommendations (see chart below).

Advantages:

• Treatment can be done without help.
• Does not require any skill, so every treatment will be done correctly.
• Freedom to do other things during treatment, because no special position or breathing techniques are required.
• Treats all lobes of the lung at once, so treatment time is shorter than manual CPT.

Disadvantages:

• New models of the vest can cost between $15,000 and $20,000, and may not always be covered by insurance.
• Requires access to electricity.
• Must bring equipment with you when traveling. The compressor weighs between 10 and 30 pounds, depending on the model.

How and Where to Get an HFCWO Vest

HFCWO vests are only available by prescription. If you are considering using the vest, talk to your healthcare provider or CF treatment center team.

Cystic Fibrosis Healthcare Provider Discussion Guide

Get our printable guide for your next healthcare provider's appointment to help you ask the right questions.

Download PDF

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