Association of Chartered Physiotherapists in Cystic Fibrosis statement on the VEST

High Frequency Chest Wall Oscillation (HFCWO) – an electric air pulse generator that connects to an inflatable jacket (vest) to vibrate the chest. Read the statement below by the Association of Chartered Physiotherapists in Cystic Fibrosis, regarding the current evidence behind the VEST.

Effective airway clearance techniques (ACT) can be achieved in a variety of ways.

The evidence for ACT in people with cystic fibrosis has been analysed in 8 Cochrane reviews published between 2000 and 2018.There is currently insufficient evidence to suggest that one technique is better than another.

However two recent well-constructed studies in cystic fibrosis show that if using High Frequency Vest Oscillation, (the Vest), the patients may not breathe as well using it or may get more infections and get them more quickly. These studies were done in children. There are at least two studies in adults that show less or just the same amount of secretions cleared with the Vest compared to other techniques.

The ACPCF therefore recommends that the Vest is not used as the only ACT especially in children with cystic fibrosis. The ACPCF recognises that some patients may prefer to use the Vest and feel benefit from using it. We advise people thinking about wanting to use the Vest to discuss the pros and cons with their physiotherapist. The ACPCF recommends that for people with cystic fibrosis choosing to use the Vest some other ACT such as at least huffing and coughing is done with the Vest on.

Physiotherapists should consider patient choice and circumstances, and clinical reasoning of the person with cystic fibrosis’s signs and symptoms when recommending techniques. Techniques may be combined depending on patient needs.

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