High Frequency Chest Wall Oscillation
High Frequency Chest Wall Oscillation, or HFCWO, works by wearing an air filled vest that is connected to a compressor pump that vibrates the lungs. The speed and pressure of the vibration force can be adjusted the way you like it. Also, different sized vests allow it to grow with you. A treatment should last 20-30 minutes; huffing and coughing will increase the amount of secretions you release. Huffing
Huffing allows you to move mucus up through the airways. To do this, breathe out hard, pushing mucus from deep in the lungs into the larger airways, where it can then be coughed out. Unlike coughing, huffing doesn’t collapse airways, but rather provides a gentle squeezing to move the mucus up. Picture a tube of toothpaste. If you squeeze just below the opening, you’ll get a tiny bit of toothpaste out. But if you start low and gently squeeze while working your way up, you will get much more toothpaste out. Similarly, huffing allows you to clear more mucus up because you are gently working it up from the bottom of your lungs. To Huff
Breathe in using your diaphragm (i.e. belly breathing).
Hold this breath for 3 seconds.
Tilt your head up slightly.
Blow out hard and slowly through a wide open mouth (like you're fogging up a mirror, NOT like blowing kisses). You should not hear any wheezing.
You should blow out for about 4 seconds. Active Cycle of Breathing
Active cycle of breathing techniques, or ACBT, consist of three different breathing patterns to clear secretions—breathing control, thoracic expansion, and forced expiratory technique. Each one can be performed by itself or in combination with other forms of airway clearance. Breathing Control
In “belly breathing,” or diaphragmatic breathing, you use your diaphragm---the muscle between your chest and abdomen—to breathe while keeping the upper chest and shoulders relaxed. Breathing this way allows you to rest while performing ACBT. It also prevents airway obstruction. The length of this phase depends on how bad your symptoms are. Thoracic Expansion Exercise
This deep breathing exercise is all about breathing. First, you fill your lungs and then hold your breath for 2-3 seconds before breathing out. This allows the air to get behind the mucus to help move it up. You should take 3-4 deep breaths in this phase. Forced Expiratory Technique
Combining huffing and breathing control, you breathe in deeply, hold for 2-3 seconds, then breathe out slowly and forcefully, as if you were trying to fog up a mirror. Repeat 2-3 times and cough, if needed, to clear secretions. After using this technique, follow up with breathing control. ACBT helps you move secretions up so you can clear them. Alternate between breathing control and thoracic expansion exercise until you feel the need to cough, and always return to breathing control after huffing to prevent the airways from tightening back up. You can also use postural drainage positions and HFCWO. Autogenic Drainage
You can do this by inhaling different amounts of air to move secretions from the smaller, outer airways to the larger ones. But it takes a lot of breathing control to do this well. Breathing at low-lung volumes is called the collecting phase because it loosens mucus from the airway walls. Breathing at mid-lung volumes is also called the collecting phase because it moves mucus into the larger airways. The final phase, which involves breathing at larger lung volumes to cough and clear the secretions, is called the evacuating phase. Your CF team can help teach you how. Games
Games and toys can help strengthen your lungs and develop breathing control, while making therapy fun. Horns, flutes and harmonicas are a great way to practice breathing control and to give your lungs a good work-out. Cotton ball races—blowing cotton balls across a table with a straw—is a good game that you can play with your brothers or sisters siblings, friends or parents. Blowing bubbles, pinwheels and kazoos also make treatment fun. 
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