Respiratory Physiotherapy

CF is one of the conditions we commonly help children and parents to manage, we closely alongside the Doctors, Nurses and other members of the Multidisciplinary Team to support you to become confident in the management of your diagnosis.

The Cystic Fibrosis Trust website Cystic Fibrosis Trust Homepage | CF Trust has a lot of amazing information on it to look through.

Here is a list of easy read leaflets on respiratory physiotherapy Physiotherapy resources (cysticfibrosis.org.uk) for people with CF.

Or for a more detailed document, here is their Standards of Care and Good Clinical Practice for the Physiotherapy Management of CF. 

What you and your child tells us, including in our questionnaires, is key to helping us monitor how your child's lungs are doing.

One commonly used questionnaire for those with CF is the such as the Cystic Fibrosis Questionnaire Revised (CFQ-R)

Spirometry is a common and easy test used we use to measure how well the lungs are working (pulmonary function).

It involves breathing in as much as you can before blowing out as quickly as you can into a small device, called a spirometer. This measures the speed and the amount (volume) of air that is moving in and out of the lungs.

Other variations on spirometry are also used including the Lung Clearance Index (LCI) which involves the multiple-breath washout (MBW) test. This is simply breathing normally into a device and the Impulse Oscillometry System (IOS) and is easy to perform with children.

Children and young people with respiratory conditions tend to get frequent respiratory infections, caused by bacteria or fungi.  We can detect and identify these bacteria or fungi though a sputum sample, which is where you will cough some mucous into a pot which will be sent for testing. so we can prescribe the most effective antibiotics. We look at amount, weight, colour, and ease of coughing up the mucus.

This is recommended at least annually for CF patients to help us monitor how your child and your child's lungs are doing. Some examples include:

• Modified shuttle walk test

Your physiotherapist will work with you to develop a treatment plan which best works for you and your family, and your daily family life.

Physical activity and exercise

Physical activity and exercise is very important for people with CF and other lung conditions, at any age as It encourages you to take deep breaths and breath faster helping to preserve the elasticity of the lung walls and helps to clear mucus.

Some studies have shown physical activity and exercise to improve:

•    Aerobic fitness
•    Exercise capacity
•    Pulmonary (lung) function
•    Clearing mucus from lungs
•    Maintaining blood sugar levels
•    Bone mineral density (reducing risk of bone fractures)
•    Quality of life

Your treatment plan is likely to include a combination of fun physical activity that they enjoy with friends and family, aerobic training, resistance/strength training.

Here are just a few examples of ways to help your child clear sputum (phlegm) for the lungs. Your physiotherapist should go through this with you and your child before you try yourself.

Active Cycle of Breathing Technique (ACBT)

ACBT combines different breathing techniques that help clear mucus from the lungs in three phases.

PEP

PEP stands for positive expiratory pressure and helps to open up your airways and get air behind the mucus to help it move higher up in your airway. Once it gets into the back of your throat, you can huff and cough the mucus out. It is usually given in one of two ways:

PEP Mask
This is a mask that covers the nose and mouth which has a resistor that fits into it. When you breath in and out through the mask pressure builds up in the lungs, which helps to keep the airways open, and encourages the air to get behind the sputum helping to moves it up so it can be coughed out more easily.

There are different colour resistors which increase the amount of resistance the mask offers.

Please see the leaflet on how to use your PEP mask: 

Oscillating PEP
An Oscillating PEP device is similar to standard PEP mask, but this time as you as well as getting the resistance or back pressure in your airways, it also vibrates your airways. These vibrations can help loosen the mucus away from the airway walls, allowing it to be cleared from your lungs. 
Different devices are available, and your physiotherapist will help to decide which one is best for you.

Aerobika®
The Aerobika provides slight resistance as you breathe out through it. This creates some back pressure in your airways which helps them to stay fully open.

A rocker mechanism within the device causes the air travelling from your lungs to vibrate, which helps loosen secretions from the airway walls.
It is great for children and also works as part of combined therapy with saline to aid clearance and adherence

Acapella® Choice
When you breathe out through the Acapella, air flows through a counterweighted plug which will help keep your airways wide open to get air behind sputum to help move it upwards.

The magnet directs the air through a pivoting cone generating vibrations that are transmitted to the chest wall to help loosen sputum from the sides of your airways.

Please see this leaflet on the Acapella Choice for more information

Flutter®
When you breathe out through the Flutter pressure builds up in your lungs. This helps to keep the airways open wide and also allows air to get behind sputum and help move it upwards.
The vibrations transmitted through the chest wall by the action of a steel ball also help to loosen sputum from the sides of the airways.

Please see here for more information