July 2002 / Volume 47 / Number 7 / Page 823
Airway Clearance Strategies for the Pediatric Patient
IntroductionClinicians who care for cystic fibrosis (CF) patients have many techniques to choose from to facilitate mucus clearance. Little has been published about when to introduce the various techniques and in what order to teach them. Debates have occurred over these issues in the CF community, and there is now consensus on some topics. It is very important to teach adherence to therapy at an early age. Adherence to an airway clearing regimen assists in maintaining good pulmonary function in CF patients. Knowing when and how to introduce airway clearance techniques beyond chest physiotherapy (CPT) is clinically relevant and useful. A 5-position modified CPT routine can be used with infants and children, and it takes less time and may improve adherence. Infants and toddlers can be taught breathing games that eventually lead them to perform diaphragmatic breathing and huffing. Once they have mastered diaphragmatic breathing and huffing, children can be taught the active cycle of breathing technique. Modified CPT can be phased out at that point. Positive expiratory pressure therapy can usually be introduced around 6-7 years of age. High-frequency chest wall oscillation, oscillating positive expiratory pressure, and autogenic drainage all follow. CF patients should be given every opportunity to learn and master various techniques to promote mucus clearance.
Diaphragmatic Breathing and Huffing
Active Cycle of Breathing Technique
Positive Expiratory Pressure Therapy
High-Frequency Chest Wall Oscillation
Oscillating Positive Expiratory Pressure
Airway clearance techniques for pediatric and adult patients have improved and changed dramatically over the last 10 years in the United States. There is an abundance of literature about the various techniques: some is good science; some not so good. But all of it boils down to enhancing the ability to clear secretions from the airways of sick lungs. The respiratory therapist is responsible for introducing patients to the various techniques at the appropriate ages. Not much has been published with regard to when to start the various techniques, which techniques are clinically useful at what age, and in what order we should teach them. This review addresses those questions with regard to pediatric cystic fibrosis (CF) patients. My purpose here is not to discuss the pros and cons of the science behind the techniques or how to do the techniques, but, rather, when, how, and why to incorporate them into the life of a young CF patient. Many of the airway clearance techniques can be used with other patient populations as well, but the focus here is to provide information clinically relevant and useful to CF patients.