Friday, May 9, 2014

Airway Clearance

Airway clearance is a major part of CF care and maintenance.  There are various ways that patients and their caregivers can administer the clearance therapies, and some of the techniques used can vary by country.  Some techniques can be done by the patient (if they’re old enough to take charge of their care), while others require someone else to assist them.

The whole point of airway clearance is to loosen and move the abnormally thick, sticky mucus out of the lungs so patients can (hopefully) breathe better.  Getting all of the mucus out can also help reduce the severity of lung infections (

One of the first airway clearance techniques parents of infants use on their child after diagnosis is manual chest physiotherapy, or CPT.  The parent or caregiver can use a cupped hand or a special percussion cup to clap over the lungs in specific zones for a set amount of time.  This is the method we used with Judith for almost 2 years until she was big enough to qualify for another method of airway clearance.

In the US, inflatable vests are a popular and common form of airway clearance, called High-frequency chest wall oscillation, or HFCWO.  I see 3 brands mentioned most often among other CF parents: The Vest by Hill Rom, Smartvest by Electromed, and the InCourage by RespirTech.  The patient puts on a cloth vest that has an inflatable bladder inside, connects the vest to a generator with a hose (or 2 hoses depending on the system), then starts the generator for the specific amount of time that the CF team recommends.  As patients get older, they will often let the vest run for a few minutes, set the program to automatically pause so they can huff cough to expel the loosened mucus, and repeat for the duration of the treatment.  Judith isn’t old enough to understand how to huff cough yet, so her treatments run straight through.  Our team wants her to do 30 minutes twice a day, which seems to fit with the average of 20-30 minutes that I’ve heard about from other CF parents.  Vest systems are hard to come by for patients outside of the US because other countries often will not pay for the systems, so if a patient wants one they often have to pay out of pocket for a new system or a used system.  There is some debate about whether or not the vest systems do a better job than manual CPT or other methods.

Another technique that older patients can use is Oscillating Positive Expiratory Pressure (Oscillating PEP).  To do Oscillating PEP, the patient blows into a device that then vibrates the large and small airways to help loosen the mucus (  2 devices I’ve heard mentioned frequently for Oscillating PEP are the Flutter and Acapella, but there are other brands available.

During normal treatment plans, most patients perform airway clearance twice a day, but some may do it more frequently depending on their individual case.  During sick plan, patients are often performing airway clearance at least 3-4 times a day to help get rid of excess mucus that’s building up, and to hopefully keep more serious infections from setting up camp in the lungs.  Airway clearance can be pretty time consuming, particularly during sick plan, but it’s necessary to do it regularly.

There are other forms of airway clearance that I didn’t cover, and if you would like to read more about them, you can find them by following the source link at the bottom of this post.


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