Using Airway Clearance Therapy to Prevent & Treat Pulmonary Diseases

July 14, 2019

Airway clearance therapy, or ACT, is a cornerstone technique for the prevention and treatment of pulmonary diseases. 

Thick, sticky mucus must be cleared from the lungs to keep infections low and function improved. This is usually done by coughing or huffing. The therapy is designated for individuals whose cough mechanics are altered and whose ability to mobilize and clear airway secretions is compromised.

Treatment therapies are making measurable strides. And devices that offer relief to those suffering any number of lung diseases have become increasingly advanced.

One device, AffloVest, is an example of this new technology. The device was featured in the 2019 CBS film, “Five Feet Apart,” and is now offering help to a local resident.

Brian Simpson of St. Marys, Clinical Documentation Specialist in Case Management at Penn Highlands Healthcare, who is also a respiratory therapist, describes his journey, one that started at a very young age.

"I have had asthma my entire life, worsening significantly in my early 20s,” said Simpson. “By the time I was 25, my lung function had dropped below 30 percent of predicted.  Over the years, and despite never having smoked, I developed stage 4 COPD (chronic obstructive pulmonary disease)."

In 2001, for a period of almost three years, Simpson was unable to work and required oxygen 24 hours a day. However, "through determination," Simpson said, "I was able to return to work and remained fairly stable until 2016."  

Unfortunately, that year, Simpson faced another setback, a rapid decline in lung function. "I had just finished my 18th full marathon (and these were all done with a lung function of 28-32 percent)." Simpson continued, "In a matter of two weeks my lung function decreased to 14 percent and I was again on oxygen 24/7."

"After two months though, I was able to return to work in my position in Case Management, Simpson said. “It was in this time period that in addition to severe chronic asthma and COPD, I had now developed a condition known as bronchiectasis. This is a dilation of the airway that involves mucus and the inability to clear it from the lungs.  As the mucus is not effectively removed from the lungs, chronic infections develop." 

Before being introduced to the AffloVest technology, Simpson continued with traditional therapies. "In addition to inhaled medications, HFCWO (high-frequency chest wall oscillation) is used to treat bronchiectasis,” he said. “This therapy involves vibration and percussion (tapping against the chest wall)  as extremely fast rates and is delivered by wearing a special vest.  The standard system utilizes a vest and two long hoses that are attached to the machine that delivers the percussion."

While effective, this method comes with its own set of obstacles. "It requires you to be sitting in one place for the duration, which is typically 20-30 minutes two to three times a day,” Simpson said. “It was effective for me, but the percussion is delivered through constant percussion and vibration.  It became more and more difficult for me to tolerate, with such low function.  It was difficult to breathe against and effectively cough to remove the mucus."

It was during this time that Simpson was introduced to the AffloVest system. Simpson describes some of the benefits, "One way the AffloVest is different from the traditional system in that it is portable and does not require you to be in one position.  There are no hoses to tie you down. It is battery powered."

It is the unique way that AffloVest works that offers Simpson the greatest relief. "Although the portability is great, it is the way this system delivers the therapy that makes it better for me," Simpson said.  "It is not a consistent percussion and vibration like the traditional systems, but rather it delivers the therapy in a more natural way.  It is intermittent and moves throughout the lung areas, allowing for a more natural breathing pattern."

"It is very similar to what is known as chest physiotherapy (CPT) that is delivered manually.  This therapy, however, is not always easy to deliver as it requires the assistance of another person to do the percussing on the chest," Simpson added.

Exercise, in general, is the best form of airway clearance. The ability to add the AffloVest to physical activities creates a perfect combination. "Another great benefit of the AffloVest system is the ability to use it while exercising," Simpson explained.  "I have been able to use it while walking on the treadmill or while taking my dog for a walk outside.”

Simpson continues to experience the successes of the AffloVest system, remarking, "I have definitely seen a decrease in the number of chest infections I have had since starting using the AffloVest.  The great thing about that is the fewer infections, the fewer antibiotics."

Brian Simpson resides in St Marys, where he enjoys the company of his 11-year-old English springer spaniel, Duke.

AffloVest requires a prescription from a doctor, such as a lung specialist at Penn Highlands Healthcare, for treatment by high frequency chest wall oscillation, or HFCWO. For more information about lung care at Penn Highlands, go to