 | | | | A CF patient receiving instruction in airway clearance techniques. |
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Airway clearance is very important as it removes mucus from the lungs, preventing build up and infections. CF patients should perform some form of airway clearance technique one to two times a day and at least three times a day when they are feeling sick. The types of airway clearance techniques patients may use will change throughout their lifespan. Patients should choose a technique they will want to do every day. Chest Physical Therapy (CPT)
CPT consists of three components: • Postural drainage
• Percussion
• Vibration
This type of clearance is started in infancy and childhood. It is a passive form of treatment for the patient and an active one for the caregiver. A good analogy for CPT is getting ketchup out of a ketchup bottle. You turn the bottle over (postural drainage), hit it on the side of the bottle to loosen the ketchup (percussion), and then shake the bottle to allow the ketchup to flow out of the bottle (vibration). For a brochure on chest physical therapy click here. Postural Drainage
This technique uses a series of gravity dependent positions to drain mucus from the lungs. Positions are limited for infants, keeping them upright or side-lying because they tend to spit up. Older children can tolerate all of the positions that an adult performs. Patients with reflux disease should avoid any head-down positions, as it may increase reflux. Percussion
Using cupped hands or a manual device, caregivers create a hollow clapping sound to loosen lung secretions. For infants, the percussion is made with 2-3 fingers, a bottle nipple, or a percussor cup, and is performed for approximately 2-5 minutes in each position. For older children and adults, CPT is performed using the whole hand, and even doing both sides simultaneously, for a session lasting 25-30 minutes. Vibration
By using their hands or manual devices on the chest, caregivers can vibrate or shake secretions from lung walls, allowing the patient to clear them by coughing. In infants, this force can be created by using “Tickle Me” toys, a bouncy seat with vibration, or bouncing the baby on your knee. Using a trampoline, tumbling, performing wheel barrow races, and tickling are good ways to achieve this with older children. Creating a vibration force in adults is done using one or two hands to vibrate over the specific lung segment. PEP Therapy
Positive Expiratory Pressure (PEP) therapy is done by breathing through a device that provides resistance while exhaling. This pressure keeps the small airways of the lungs open to improve the mobility of the secretions. There are many different forms of PEP therapy: Acapella®, Flutter®, TheraPEP®, and Bubble PEP®, are some. Each treatment should be done twice a day for 15-20 minutes. Acapella®
This oscillating device provides pressure to shake secretions from the lung walls. It comes in two different levels of PEP (blue for younger children and green for older children and adults), each adjustable. The Acapella® can be used in any position and can be combined with postural drainage positions. The Acapella® is great for kids starting PEP therapy.
Flutter®
Unlike the Acapella®, this oscillating PEP device does not come in different levels of PEP and is not adjustable. Therefore, it’s more difficult for younger children to use. TheraPEP®
This PEP device comes with a visual coach to assist the patient with the exercise. There is no oscillation, but the device has six different settings, which make it easier for younger children to use. Bubble PEP
This is an easy, cheap and fun way for children to do their airway clearance every day. To make a bubble PEP, fill an empty milk jug half way with water; then insert a rubber tube for the child to blow through. Picture blowing bubbles in a glass of milk. Food coloring can be added to make it even more fun for the kids, friends and family.
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