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 technique starts in infancy and childhood. A passive treatment for the patient and an active one for the caregiver, CPT can be compared to 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).
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
By cupping their hands, caregivers create a hollow clapping sound to loosen mucus in the lungs. For infants, the percussion is made with 2-3 fingers, a bottle nipple, or a percussor cup. Each method takes about 2-5 minutes. For older children and adults, CPT is performed using the whole hand, and even doing both sides simultaneously. Sessions last 25-30 minutes.
Vibration
By using their hands or manual devices on the chest, caregivers can create vibrations that shake secretions from the walls of the lung, 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. In adults, use one or two hands over a specific area of the lung to create vibrations. PEP Therapy
Positive Expiratory Pressure (PEP) therapy is done by breathing through a device that provides pressure while exhaling. This pressure keeps the small airways of the lungs open to improve the movement of secretions. There are many different forms of PEP therapy, including Acapella®, Flutter®, Therapep®, and Bubble PEP. Each treatment should be done twice a day for 15-20 minutes. Acapella®
The Acapella® provides pressure to shake mucus from the lung walls. It comes in two different levels of PEP (blue for younger children and green for older children and adults) and can be adjusted to hard or easy. The Acapella®, which can an be used in any position and combined with postural drainage positions, 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, its 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
Blowing bubbles is an easy, cheap and fun way for children to do their airway clearance every day. Fill an empty milk jug half way with water; then insert a rubber tube to blow through. Its just like blowing bubbles in a glass of milk! Food coloring can be added to make it even more fun for the kids; friends and family members will enjoy it, too. 
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