Physiotherapy Management of Cystic Fibrosis

Cystic fibrosis (CF) is a progressive, genetic disorder that affects multiple organs, including the lungs, pancreas, intestines, liver, and others. It causes persistent lung infections and gradually limits a person’s ability to breathe over time. The damage often results from the buildup of thick mucus that clog the airways and traps pathogens. For this reason, minimising contact with microbes is a top concern for people with CF, with chest physiotherapy being an integral part of its management.

CF alters the cells that produce mucus, sweat, and digestive enzymes. Under normal conditions, these secreted fluids are smooth and thin like olive oil. Their job is to lubricate tissues and organs, preventing them from becoming too dry. In people with cystic fibrosis, the fluids become thick and sticky due to a mutation in a faulty gene. So instead of being a lubricant, it clogs tubes, ducts, and passageways in the body, which can lead to life-threatening problems.

For many years, physiotherapy for cystic fibrosis meant a daily routine of postural drainage and percussion. Today, a clearer understanding of the disease’s pathophysiology has led to the development of many airway clearance techniques, physical exercise, and postural care that address unique complications of CF.

1. Airway Clearance

Therapists use a combination of active cycle of breathing techniques (ACBT) to mobilise and clear excess pulmonary secretions, improve the effectiveness of cough, and improve lung function. It consists of three main phases:

• Breathing control – This period of relaxed breathing is used to relax the airways and relieve the symptoms of wheezing and tightness. The patient is instructed to breathe gently in and out through the nose, releasing any tension and keeping the shoulders relaxed.
• Thoracic expansion exercises – This technique includes deep breathing exercises that focus on inspiration to loosen lung secretions. The patient is usually asked to keep the chest and shoulders relaxed while taking a long, slow, and deep breath in through the nose if possible. The air should be held for 2-3 seconds before breathing out.
• Forced expiration technique – Also known as huffing, this technique is used to move secretions through deep breathing exercises towards the mouth. A huff is exhaling through an open mouth and throat, rather than coughing.

2. Postural Drainage

An essential part of cystic fibrosis therapy, postural drainage involves positioning the body to allow secretions to drain from the smaller airways into the central airway due to gravity. The physiotherapist will instruct and advise on the specific postural drainage positions required.

3. Percussion and Vibration

• These techniques are used to loosen and mobilise secretions. The physiotherapist may advise lying on either side, your front or back, and sitting.
• Percussion, also known as ‘chest clapping,’ refers to clapping the chest firmly and rhythmically over a layer of clothing or a towel for approximately 15-20 seconds, with pauses of five seconds or longer, over the area being drained.
• Vibrations or ‘chest shaking’ are done at the end of the position. It refers to short, rhythmic squeezes to the chest wall as the patient exhales.

4. Physical Exercise

In every Dubai physiotherapy clinic, the management plan for CF patients includes physical activity. Physiotherapists work with patients to help them exercise safely. It is believed that aerobic exercise is a supplement to airway clearance techniques, but in small proportions to adults.

With modern treatment and help from experienced physiotherapists, cystic fibrosis can be managed. For more information on how physiotherapy can help, book an appointment with Scandinavian Physiotherapy Centre. They offer manual therapy that can benefit CF patients. Call +971 4 551 6126 today!