RESPIRATORY CARE Choices for Cystic Fibrosis Patients and Respiratory Therapists
Cystic Fibrosis is characterized by thickened mucus, chronic infection and inflammation of the airways. Patients with this disease engage in daily respiratory therapy. Effective respiratory care can vary widely, depending on the needs of the individual.
Among the therapies available are:
- Chest physiotherapy – the standard for airway clearance
- Active cycle breathing using huffing
- Autogenic drainage involving breathing in different lung volumes
- Positive Expiratory Pressure (PEP) consisting of either low pressure PEP, high pressure PEP, or oscillating PEP
- Intrapulmonary Percussive Ventilation providing continuous oscillating pressures during both inhalation and exhalation
- High-Frequency Chest Compression that provides oscillation to the external chest
- Exercise as supplemental to other forms of treatment
Determining the best course of action is a function of many variables with age being one. As a point of illustration, Table 1 suggests the most appropriate type of airway clearance by age.
Table 1: Airway Clearance Techniques by Age Group
| Technique | 0-3 Years |
3-9 Years |
>9 Years |
| Chest physiotherapy | Yes | Yes | Yes |
| Active cycle of breathing | No | Yes | Yes |
| Autogenic drainage | No | No | Yes |
| Positive expiratory pressure (PEP) | No | Yes | Yes |
| Oscillating PEP (Flutter or Acapella) | No | Yes | Yes |
| Intrapulmonary percussive ventilation | No | No | Yes |
| High-frequency chest compression (The Vest) | No | Yes | Yes |
| Exercise | Yes | Yes | Yes |
Source: Jeffrey S. Wagner MD and Aree A Headley RRT, “Cystic Fibrosis: Current Trends in Respiratory Care,” Respiratory Care March 2003 Vol 48 No 3 p.240 Table 2.
Those involved in determining which therapy to use are the primary doctor, the respiratory therapist, and the patient. The respiratory therapist is a key figure because they communicate with the doctor and the patient, including the decision as to which therapy to use. The pivotal role of the respiratory therapist is captured in the following video of the American Association for Respiratory Care.
The interests of the respiratory therapist are illustrated in the use of chest physiotherapy (CPT). With CPT, pressure is applied to the thorax from clapping, vibration or compression and is combined with postural drainage in order to dislodge mucus and move it out of the airways. CPT is repeated over different parts of the chest until each area of the lung is cleared. The repetitive action is of concern to respiratory therapists since it could lead to carpal tunnel syndrome.¹
Although respiratory therapists have the option of using mechanical devices to minimize the strain on their body, they are advised that: “Mechanical devices…do not always clear the airways better than manual techniques.”² In fact, this is true for all forms of airway clearance techniques. A nationwide Cystic Fibrosis Foundation committee established to examine the clinical evidence for different therapies and provide guidance on their use concluded: “There are no ACTs [airway clearance therapies] demonstrated to be superior to others, so the prescription of ACTs should be individualized.”³
Mechanical devices used in CPT not only provide relief for respiratory therapists, but may allow patients to perform CPT on themselves. The Electro Flo® 5000 Airway Clearance System with the Self-Administrator® strap allows patients to easily direct CPT to their back as well as front and sides. Furthermore, with its 30 targeted settings, the range of Electro Flo‘s power and speed far exceed all other products. These important considerations may make a difference in patient preferences and clinical outcomes.