Johns Hopkins All Children's Hospital

Airway Clearance

The Cystic Fibrosis Center has expertise in medications and techniques to help CF patients keep their airways clear.

Airway clearance is vital for people with cystic fibrosis. The lungs build up sticky, thick mucus, causing a host environment for bacteria that leads to an increase of chronic respiratory infections. Airway clearance helps to rid the lungs of excess mucus using inhaled medications in combination with other therapies that move mucus up and out of the lungs. These therapies are designed to work best when performed at least twice per day.

Medications that may be used to improve lung function include:

  • Antibiotics (inhaled, oral or intravenous)
  • Bronchodilators
  • Cystic fibrosis transmembrane conductance regulator (CFTR) modulators
  • Inhaled corticosteroids
  • Mucolytics

Your child’s physician will talk with you about the medications that are most appropriate for his or her individual condition, as well as the recommended daily order of medications and other airway clearance techniques.

Airway clearance techniques

Airway clearance techniques reduce lung infections and improve overall lung function. Several techniques have been proven effective to help maintain healthy lung function and decrease the risk of infections or further damage to lung tissue.

The technique you and your child use will depend on things like your child’s age and individual condition. Our cystic fibrosis team can help you choose the airway clearance techniques and other treatments that best meet your child’s needs.

Airway clearance techniques include:

Active cycle of breathing technique (ACBT)

ACBT combines three phases of breathing techniques to relax the airway, clear mucus from the lungs and then force the mucus out of the lungs.

Autogenic drainage

This technique involves using different breathing speeds to move mucus from the lungs.

Chest percussion therapy (CPT), also called manual percussion

The patient sits or lies in different, specific types of positions to use gravity to help drain the mucus. Each position is designed so a major area of the lungs is facing downward. The patient may use deep breathing or types of coughing to help loosen and clear the mucus, or the parent, caregiver or therapist may use clapping or percussion techniques on the patient’s chest to help move the mucus.

Exercise

Regular exercise or physical activity can help improve lung function for children with cystic fibrosis, as well as provide other health benefits like supporting bone strength.

High frequency chest wall oscillation vest

The patient wears an inflatable vest that’s attached to a machine. The machine causes the vest to vibrate at a high frequency, which loosens and thins the mucus in the lungs and airway, allowing the patient to clear the mucus by stopping to cough periodically while using the vest.

Huffing coughs

This is a type of coughing that moves mucus from the lungs, and is done in combination with other airway clearance techniques. Huffing coughs involves breathing in, holding the breath to allow the air to separate the mucus from the lung walls, and then exhaling forcefully to remove the mucus.

Positive expiratory pressure (PEP)

This is a breathing technique that uses a mask or handheld device to help patients break up mucus and move it out of the lungs and airway. These devices allow air to flow freely as the patient breathes in, but creates resistance as they breath out, which allows the air to get behind the mucus to better break it up.

Resources for patients and families

The Cystic Fibrosis Foundation has a number of resources available for patients and families about CF treatment, including information specifically on airway clearance

Contact us

For more information about airway clearance or to schedule an appointment in the Cystic Fibrosis Center, please call 727-767-3995.