Cystic fibrosis physiotherapy
Physiotherapy is a crucial part of the daily treatment regime required to keep people with cystic fibrosis (CF) fit and healthy. It can be used for airway clearance, sinus management, back and continence problems, staying fit and much more.
Physiotherapy is a vitally important part of treatment and can be started as a baby, depending on their symptoms. It covers many things, including airway clearance to help loosen and remove the mucus that builds up in the lungs, exercises, and techniques for good posture and to avoid back problems that can have a negative impact on lung function.
The type and duration of physiotherapy will be different for everyone, and it can be adapted to suit your needs. Your CF Physiotherapist will work with you to find the best routine for you.
We have worked with the Association of Chartered Physiotherapists in Cystic Fibrosis (ACPCF) to produce information on physiotherapy, to complement the advice and teaching physiotherapists give people with cystic fibrosis. Head over to our physiotherapy resources page to see what we cover.
What daily physiotherapy for people do?
Physiotherapy for CF is very broad. People with CF will have a physiotherapy routine which suits their age and ability and their health. It may include airway clearance; exercise and movement; inhaled treatments; sinus management; or managing or treating joint, back and continence problems. It may also be designed to treat a certain problem, to improve strength and fitness, or both.
Why is airway clearance important?
Airway clearance is important because it helps to stop thick mucus from building up and blocking airways in the lungs. This helps to reduce infection and slows damage to the lungs.
What different types of airway clearance are there?
There are many different types of airway clearance you can do, also referred to 'airway clearance techniques'. Everyone's lungs are different, and the amount of airway clearance needed will vary from person to person. No one technique has been shown to be better than another, and this may be because each person's chest can behave very differently. People may also prefer different techniques at different times in their life.
Your specialist CF physiotherapy will work with you to find the technique, or mix of techniques, that work best for you. It is important that you are happy with the technique you're using, as physiotherapy is done daily.
Some airway techniques don't need equipment and focus on breathing exercises to clear mucus. These includes:
- Active Cycle of Breathing Techniques (ACBT) – a cycle of deep breathing, huffing, coughing and relaxed breathing to move mucus.
- Autogenic Drainage (AD) – moves mucus from smaller to bigger airways using controlled breathing at different levels. Uses fast flow rates as you sigh out but ensures the airways are kept open.
Other techniques use a device to help to clear mucus. Some use positive pressure to hold open the airways and some also create vibrations within the airways, like:
- Positive Expiratory Pressure (PEP) – breathing out through a mask or mouthpiece against a resistance to build up pressure behind mucus to move it.
- Oscillating Positive Expiratory Pressure e.g. Flutter®, Acapella® – breathing out against a resistance to create PEP and also vibrate your airways to move mucus.
- High Frequency Chest Wall Oscillation (HFCWO) – an electric air pulse generator that connects to an inflatable jacket (vest) to vibrate the chest. Read a statement by the Association of Chartered Physiotherapists in Cystic Fibrosis, regarding the current evidence behind the vest.
You can read about these techniques and devices on our website.
Discuss any new airway clearance techniques that you would like to try with your CF physiotherapist (there are also other devices not mentioned above). They will discuss whether there is good research for the device and whether there are any positives and/or negatives to consider. It is also important to know that airway clearance devices are included in the funding that CF centres get, and if your CF physiotherapist has recommended that you try a particular device, then this should be provided for you.
How much airway clearance do you need?
The length and number of airway clearance sessions will vary from person to person, and may need to increase if you have a chest infection.
For few or no lung secretions, treatment sessions may only need to last 10–15 minutes, but if there are many it could take 45–60 minutes. Most people do two treatments a day, but the number and length of your sessions may need to increase depending on the volume of secretions your lungs are producing. If no mucus is present, exercise may play a greater role in your airway clearance techniques. Your CF physiotherapist will be able to advise what is suitable for you.
When should airway clearance start?
A specialist CF physiotherapist should assess all newly diagnosed people with CF and advise when and how they should start doing airway clearance. This may not start immediately for babies with no symptoms, and exercise/activity may play a greater role. At all ages, the advice will be based on an individual assessment.
Who will do my airway clearance?
The families of babies with CF will be taught how to do airway clearance with their child. As you grow older with CF, your physiotherapist will aim to find a technique that you can carry out independently, so that you do not have to rely on someone else to help.
Breathing exercises can be introduced from the age of two to three as a game. Older children can start doing airway clearance themselves with supervision. Most teenagers and adults become completely independent, and only need help if they have increased mucus.
What about exercise?
Exercise helps with general fitness, health, well-being, and bone health. Improved fitness has been shown to be important in the long term prognosis of CF, and people with CF should aim to maintain an active lifestyle. Physical exercise is also often used as part of an airway clearance regime. Exercise can help loosen mucus in the lungs and make airway clearance techniques quicker and easier. Your CF physiotherapist should be able to answer any questions about the type and intensity of exercise suitable for you.
What about your posture?
As you get older it is easy to adopt poor postures, which can lead to back pain and impact upon lung function. It is therefore important for people with CF to maintain good posture. Your physiotherapist will be able to offer advice and help to assess and treat any joint or back problems you may have. We also have a leaflet on improving your posture on our website.
What about incontinence?
Some people with CF may develop problems with urinary or faecal incontinence (leaking wee or poo) when coughing and/or exerting themselves. If this happens to you, it is important to tell your physiotherapist as soon as possible and not to be embarrassed, as they can teach you pelvic floor exercises to help. They may also refer you on to a specialist. For more information, see our leaflets on pelvic floor exercises and urinary incontinence on our website.
Many people with CF will take inhaled medications as part of their treatment. This may be to loosen the mucus, hydrate the airways, open up the airways, reduce inflammation (swelling) of the airways, and/or to get antibiotics into the lungs to treat infections. These medications may come in nebulised (inhaling a mist) or dry powder form. The timing of these inhaled medications with airway clearance and exercise is important to make sure the treatments work as best as possible. Please ask your physiotherapist for advice.
There are many different nebuliser devises available and more information on inhaled therapy can be found in the leaflets on our website.
Airway clearance for babies and young children
Looking after your child's lungs should include daily exercise and possibly daily airway clearance. This factsheet covers how the lungs of children with CF are cared for and the importance of airway clearance.
Autogenic drainage (AD) is a technique that utilises changes in your breathing and does not require equipment. Download this factsheet to find out more.
How to improve your posture
This guide explains the common postural problems that people with CF can have and shows you how you can improve your posture through simple, effective exercises.