Airway Clearance Vest Systems for Cystic Fibrosis

Hill-Rom Monarch™ Airway Clearance System
Wikimedia Commons

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 Do 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:

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 Do HFCWO Vests 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
  1. 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. 


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 of HFCWO Vest Therapy

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 physician recommendations (see chart below).

Treatment can be done without help.New models of the vest can cost between $15,000 and $20,000, and may not always be covered by insurance.
Does not require any skill, so every treatment will be done correctly.Requires access to electricity.
Freedom to do other things during treatment, because no special position or breathing techniques are required.Must bring equipment with you when traveling. The compressor weighs between 10 and 30 pounds, depending on the model.
Treats all lobes of the lung at once, so treatment time is shorter than manual CPT.


How and Where Do You Get an HFCWO Vest?

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

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Article Sources
  • Marks, J.H. “Airway Clearance Devices in Cystic Fibrosis”. Pediatric Respiratory Reviews. 2007; 8:17–23. 
  • The Cystic Fibrosis Foundation. High-Frequency Chest Wall Oscillation (the Vest).