Leila Cruikshank

Chest Physiotherapy

Chest physiotherapy is a board term describing a type of physiotherapy specifically aiming to maintain the airways clear of mucus and improve air entry into the lungs. Most people with CF know this term, which is more properly called "airway clearance therapy (ACT)."ACTs are part of the standard therapy for people with CF.

People with CF have a build-up of mucus in the lungs. Mucus is produced by cells in the deeper airways to help trap bacteria or other wastes that you may breathe in. Normally, the mucus would be transported by hair-like structures called cilia that move the mucus higher up in the airways. It can then be cleared out of the lungs through coughing or clearing the throat. In people with CF, this transport system in the airways doesn't work properly. The mucus gets trapped in the airways with different bacteria and other waste products. This can lead to more chest infections and inflammation. ACT helps remove the mucus from the lungs and clear out bacteria and other wastes that are trapped in the mucus. Research has shown that people with CF have better lung function if they do ACT, compared to those who don't.

There are many different techniques that have been developed and shown to be effective ways to perform airway clearance. To watch our video, "Breathe Easier" that introduces these techniques, click here. Below is a list of current airway clearance techniques in order of their development:

Percussions and Modified Postural Drainage
Autogenic Drainage (AD)
Active Cycle of Breathing Technique (ACBT)
Positive Expiratory Pressure devices (PEP)
Oscillating PEP

There are a few other ACTs that are newer devices. To read more about them, click here.

It is important to time your inhaled medications correctly with your ACT. This allows you to maximize the effects of both the medication and the airway clearance technique itself. For example, taking a mucolytic drug such as hypertonic saline, assists in thinning the mucus. Taking the drug before your ACT will allow the mucus to be thinner and easier to bring up when performing your ACT. To see the correct order of medications and timing with ACT, click here.

Some people find it challenging to fit daily ACT into their lifestyle. Some airway clearance techniques involve multiple steps, or need help from others. The recommendation of an airway clearance technique for an individual is based on many factors, i.e. your health status, lifestyle, your previous experience with different techniques, your preference, your funding availability, and scientific evidence. Your physiotherapist can design an airway clearance program that suits your needs. They can also assess and modify your program regularly as changes occur in your life circumstance and/or disease process.