Airway Clearance
Airway clearance techniques clear mucus and improve lung function. The thick mucus in CF requires techniques such as percussion to clear it away. In addition, deep breathing exercises and upper extremity exercises combined with deep breathing can strengthen chest wall muscles. These exercises optimize lung function, allowing maximum air exposure while minimizing work and oxygen consumption. Chest physical therapy can be performed by a trained physical therapist, a respiratory therapist, a caregiver, or even the patient, and takes a few minutes for each position.
Chest Physical Therapy | | Postural Draining | Patient is placed in a downward position allowing airway drainage with the aid of gravity. | | Percussion | Clapping on the chest with a cupped hand loosens airway secretions. | | Vibration | Caregivers create vibrations that shake secretions from the walls of the lung. | | Coughing | Coughing or deep breathing can loosen and expectorate mucus. |
Maximum drainage of the lungs will require a 20-40 minute session, at least twice a day and up to three or four times per day when the patient is ill. Good compliance with therapy is difficult because it is time consuming and often requires assistance. Many patients prefer to use mechanical devices, such as chest percussors, to allow greater independence. Mechanical Devices | | Positive Expiratory Pressure (PEP) Device | Prevents airway closure, increases lung ventilation, helps clear mucus from lungs. | | High Frequency Chest Wall Oscillation (HFCWO) | A fitted vest and pneumatic compressor delivers therapy to the entire chest. |
Jogging, bicycling, and team sports also increase chest muscle strength and may be used as part of a patient’s airway clearance regimen. Mucolytics
Mucolytics break down mucus and reduce the thickness of sputum.
What?
rhDNase or Pulmozyme®, an inhaled medication, that decreases the thickness of secretions, improves pulmonary function and reduces symptoms.
Cost?
Expensive, but sometimes obtainable through special programs by the manufacturer.
Side Effects?
Hoarseness, sore throat and change in voice.
Quick Fact?
This therapy may even benefit patients with mild-lung disease. Another mucolytic is aerosolized hypertonic saline. A seven percent saline solution, this medication is delivered through a nebulizer two to three times per day. Bronchospasm can occur with this medication but may be prevented by using an inhaled bronchodilator, such as albuterol, beforehand. Studies suggest that hypertonic saline may result in similar improvements in lung function as with rhDNase.
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