Active Cycle of Breathing Technique Versus Chest Wall Oscillations on Sputum Clearance in Chronic Obstructive Pulmonary Patients

Background: Chronic obstructive pulmonary disease (COPD) is frequently complicated by mucus retention and ineffective expectoration, contributing to dyspnea and reduced functional capacity, for which airway clearance interventions are commonly prescribed. Objective: To compare the effects of active cycle of breathing technique (ACBT) versus high-frequency chest wall oscillation (HFCWO) on clinically relevant outcomes in adults with advanced COPD. Methods: A randomized clinical trial was conducted at DHQ Hospital Narowal. Adults with stage 3–4 COPD were enrolled by consecutive sampling and randomized to ACBT plus routine chest physiotherapy or HFCWO via vest system. Interventions were delivered for 4 weeks (12 sessions; 3 sessions/week). Outcomes included FEV1% predicted, 6-minute walk distance (6MWD), modified Medical Research Council dyspnea scale (mMRC), and BMI as components aligned with the BODE index framework. Results: Thirty-eight participants were analyzed (n=19/group). At week 4, HFCWO demonstrated higher FEV1% predicted than ACBT (69.79 ± 12.73 vs 55.89 ± 9.30; mean difference 13.90, 95% CI 6.54 to 21.26; p=0.000) and greater 6MWD (418.47 ± 108.25 vs 355.47 ± 45.01; mean difference 63.00 m, 95% CI 7.50 to 118.50; p=0.025), while mMRC and BMI did not differ significantly between groups. Conclusion: Over 4 weeks, HFCWO yielded larger advantages than ACBT for airflow and walking capacity; however, baseline imbalances and dyspnea-scale inconsistencies require correction and prespecified primary-endpoint analysis for definitive inference.