The thick mucus in the lungs resulting from the disease causes repeated infections and tissue damage apart from airway obstruction. This is why a fundamental part of the treatment is to clear this mucus.
Physiotherapy can be used to clear the mucus as a daily therapy and usually commencing as soon as the diagnosis of CF is made, and more frequently during exacerbations.
It has been scientifically proved that physiotherapeutic airway clearance techniques have great effects on the patients, however it may result unpleasant, uncomfortable and time-consuming.
Keeping the airways clean of secretions helps preventing pulmonary infections and improving the lung function.
However, the commonest ones are:
Active Cycle of Breathing Techniques
This active breathing technique is performed by the patient himself, comprising three different steps:
Breathing Control: This period consists in relaxed breathing which allows pauses for rest and helps avoiding any tightening of the airways
Thoracic Expansion Exercise: This period involves deep breathing exercises, increasing lung volume to allow air to get behind any distal secretions so that they can be pushed up the airways. It can be sometimes accompanied by percussion or vibrations
Forced Expiration Technique: Forced expiratory manoeuvre causing compression and narrowing of the airways, it helps moving secretion from smaller to larger airways from where they can be cleared more easily
This Cycle would consist in the following procedure:
The cycle is repeated several times.
The position of the patient during the airway clearance techniques is going to have an important effect on the results.
Postural drainage: Also called gravity assessed positioning, consists in using different body positions to help the drainage of secretions from specific areas of the lungs and also helps to increase the air movement or ventilation to different parts of the lungs. It is usually associated to percussion technique. Different positions apply to babies, older children and adults, but the physiotherapist will recommend the best positions for each patient.
Percussion and vibration
These techniques help loosen and mobilize secretions.
Percussion: Also called chest clapping, consists in a repetitive tapping that can be done with palm cups, by hand or with a manual precursor on the chest of the patient. This technique is usually performed by a parent or carer, although some people do it themselves. It can be combined with postural drainage or the thoracic expansion exercise in the active cycle of breathing control. Percussion aids to clear secretions up and out of the lungs and increase the amount of air entering the lungs.
Vibration / chest shaking: Technique consisting in several short rhythmical squeezes to the chest wall, gentle shaking or vibrating of the chest, as the patient breathes out. This helps creating mini bursts of air flow which dislodge secretions, moving them up and out of the airways. Usually in combination with a huff or cough, to clear secretions from the lungs.