Physiotherapy Management of Cystic Fibrosis

November 27, 2020

Cystic fibrosis (CF) is a progressive, genetic disorder that affects the lungs, pancreas, intestines, liver, and other organs. It causes persistent lung infections and limits the ability of a person to breathe over time. The damage often results from the buildup of thick mucus that clog the airways and traps pathogens. For this reason, minimizing 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 to prevent them from getting too dry. In people with cystic fibrosis, the fluids become thick and sticky due to 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 in and out gently through the nose, letting go of 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 called huffing, this technique is used to move secretions by deep breathing exercises towards the mouth. A huff is exhaling through an open mouth and throat instead of coughing.

2. Postural Drainage

An essential part of cystic fibrosis therapy, postural drainage refers to placing the body in a position that allows secretions to drain from the smaller airways into the main airway with gravity. The physiotherapist will teach and advise which specific postural drainage positions are necessary.

3. Percussion and Vibration

  • These techniques are used to loosen and mobilize secretions. The physiotherapist may advise lying on either side, your front or back, and sitting.
  • Percussion or ‘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 for five seconds or longer, over the area being drained.
  • Vibrations or ‘chest shaking’ is done at the end of the position. It refers to short, rhythmical squeezes to the chest wall as the patient breathes out.

4. Physical Exercise

In every Dubai physiotherapy clinic, the management plan for CF patients includes physical activity. Physiotherapists work with patients to find ways to 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 Center. They offer manual therapy CF patients can benefit from. Call +971 4 551 6126 today!