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Cystic Fibrosis Chest Therapy 101 : Airway Clearance Techniques

Mon, 12/28/2015 - 14:26 -- IV Solutions

Airway Clearance Techniques (ACTs) are a must for CF patients. ACTs are physical treatments / exercises that help break up the mucus builds up inside the airways. ACTs help get rid of mucus inside the lungs by loosening the build ups.

Using ACTs along with medical treatments, such as inhaled bronchodilators and antibiotics, can help prevent and fight infections. Bronchodilators should be used before or during airway clearance techniques to open airways and help break up mucus. After ACTs, inhaled antibiotics should be taken to treat the newly opened airways. Combining ACTs and treatments can lead to improved breathing, more open airways and better health.

Different Chest Therapies / ACT’s

When it comes to removing mucus from the lungs ACTs are one of the most effective therapies around. Most ACTs are exercises that you can do on your own. These exercises include coughing or placing your body in various positions to break up mucus and remove it from the airways. There are other airway clearance techniques that involve machines to help loosen mucus from the airways. There are ACTs for everyone. Here’s a basic list that will help you choose which ACTs are best for you:

  • Coughing is the most basic ACT. Coughing clears out mucus by forcing it out the lungs. Often times coughing by itself cannot clear mucus out and can cause one to feel worse, it is recommended to use coughing in conjunction with other ACTs.
  • Huffing is much like a gentle cough, imagine breathing on a mirror or a window to make it foggy/steamy so you might leave a message for someone else. While huffing not as forceful as coughing it is not as violent and often works well and takes less energy.
  • Postural Drainage & Percussion (PD&P) is a therapy that involves different postures to make the mucus move on its own. Different postures are incorporated to move mucus from different sections of the lung. Gravity pulls mucus from smaller airways to larger ones where it’s easier to get rid of through huffing and coughing.
  • Chest Percussion is where chest is clapped and vibrated (using a cupped hand) to loosen mucus. This is done in various positions to target different areas of the lung and can be effective in breaking up mucus when paired with treatment.
  • Oscillating Positive Expiratory Pressure (Oscillating PEP) is where a patient blows the air completely out of their lungs several times though a machine (Types of Oscillating PEP devices include the FlutterTM, AcapellaTM, CornetTM and Intrapulmonary Percussive Ventilation (IPV)). Breathing repeatedly through these devices sends vibrations through the lungs to loosen mucus and can be very effective.
  • High-frequency Chest Wall Oscillation is when a Vest or Oscillator is attached to a machine that vibrates at a high frequency. The vibrations break up and loosen mucus and every 5 minutes the person stops and coughs or huffs
  • Positive Expiratory Pressure (PEP) Therapy gets air into the lungs and behind the mucus using extra (collateral) airways and holds the airways open, keeping them from closing. A PEP system includes a mask or mouthpiece attached to a resistor. The patient breathes in normally and breathes out a little harder against the resistance.
  • Active Cycle of Breathing Technique (ACBT) involves a set of breathing exercises. These breathing techniques can be modified to meet each patient’s needs.. It includes:a) Breathing control – Normal breathing with the lower chest while relaxing the upper chest and shoulders.b) Thoracic expansion exercises – Deep breaths in. Some use a three-second breath-hold to get more air behind the mucus. This may be done with chest clapping or vibrating, followed by breathing control.c) Forced expiration technique – Huffs of varied lengths with breathing control.
  • Autogenic Drainage (AD) means “self-drainage.” AD uses different airflows to move mucus from small to large airways. AD has three parts:a) Dislodging mucusb) Collecting mucusc) Clearing mucusd) Patients inhale to different levels and adjust how they exhale to heighten airflow and move mucus. At first, AD is challenging and takes practice.


Airway Clearance Techniques. Cystic Fibrosis Foundation. February 14, 2012. Accessed May 4, 2015

Postural Drainage: Chest Physical Therapy. May 14, 2014. Accessed May 4, 2015

Clearing Extra Mucus From The Lungs. WebMD. June 11, 2013. Accessed May 4, 2015.

An Introduction to Postural Drainage and Percussion. February 14, 2012. Accesed May 4, 2015