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AN OVERVIEW OF CASE SUMMARY

The patient who is a 53-year-old married white female was referred to a major university medical center in Kansas (United States) for evaluation of a chronic cough productive of large volumes of purulent sputum. She had a history of recurrent respiratory infections that had resulted in five hospitalizations in the past year. In the months preceding her visit to the clinic, the patient was reported to produce one and a half cups of sputum daily and requiring 2.5 liters of supplemental oxygen per minute for 12 hours each night.

During her visit, she complained of a stabbing chest pain, and it was believed by the examining physician to be pleuritic. On top of that, shortness of breath limited her daily activity considerably. Depleted by her illness, the patient reported an inability to carry out most of her daily activities. As a result, she felt discouraged and experienced episodes of depression beside her significant medical history of asthma, which was diagnosed 20 years earlier – an episode of pneumothorax and suspected COPD (Chronic Obstructive Pulmonary Disease).

In addition to the above health issues, the patient’s smoking history was estimated at 60 – 70 pack in a year even though she reported to have quit smoking for eleven years. Besides, her family history revealed that both her parents had been smokers and were diagnosed with emphysema; the patient’s mother died of lung cancer at the age of 64. Although there were no rales upon pulmonary examination, bilateral breath sounds were audible with a few expiratory wheezes at the lung bases. Chest x-rays revealed very prominent bronchial markings consistent with chronic bronchitis and possibly bronchiectasis (there was no acute infiltrates were identified).

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METHOD USED TO TREAT THE DISEASE

Following her consultation at the medical center in Kansas, the patient’s current therapy was modified to include secretion clearance. Previously, she had taken Percocet for pain, two puffs Combivent TID, three puffs Vanceril inhaler TID, Albuterol nebulizer treatments PRN, and 2.5L/min oxygen. Additionally, she continued these treatments despite an aggressive regimen of pulmonary hygiene was initiated, including routine use of aerosolized bronchodilators and airway clearance therapy to manage her copious secretions.

For secretion clearance, the patient’s pulmonologist prescribed 30-minute treatments BID using The Vest™ Airway Clearance System, which provides therapeutic airway clearance treatments using high frequency chest wall oscillation (HFCWO). To administer HFCWO, the vest component of the system is attached to an air pulse generator, which rapidly inflates and deflates the vest. Oscillation of the chest wall, subsequently, produces transient increases in airflow, cough like shear forces, and changes in the rheological properties of mucus; making it easier to mobilize. Eventually, the patient was instructed to divide her 30-minute therapy sessions into three ten-minute intervals at 5 – 10 Hz, 10 – 15 Hz, and 15 – 20 Hz respectively.

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RESULTS/FINDINGS

During her first several treatment sessions, the patient reported clearing large amounts of mucus. Then, after six-month follow-up interview, she indicated that the quantity of her daily secretions had decreased significantly, as well as the frequency and severity of her cough, even at night (she was able to reduce her use of nocturnal oxygen from twelve to eight hours nocturnally). At a follow-up consultation, one full year after beginning The Vest™ system treatments, the patient had not experienced a single respiratory infection or required hospitalization.

In addition to the above clinical improvement, the patient described notable gains in her quality of life, such as permitting her first Christmas celebration in three years outside of the hospital. She reported an enhanced ability to perform her activities of daily living, to enjoy her life more fully, and to maintain a cheerful as well as optimistic outlook. Long story short, such significant relief of her chronic shortness of breath ultimately allowed her to participate in a broad range of activities including church events, shopping excursions, attendance at sporting and cultural events, and travel out-of-state to visit her ten grandchildren.

Above all, the patient was convinced that airway clearance therapy was the critical component in her treatment process, except for a single week-long-instance of omitting The Vest™ therapy while traveling out of state where her adherence to the airway clearance therapy remained strict.