ACPCF Infant Guideline - The Knowledge Network

Appendix 3
Airway Clearance Techniques
The term airway clearance represents a number of different treatment
modalities which aim to enhance clearance of bronchopulmonary secretions.
These may include breathing techniques such as assissted autogenic
drainage; devices which deliver positive expiratory pressure and postural
drainage and manual techniques. 1
Very few studies have evaluated airway clearance techniques in babies with
CF. 2-4 Techniques commonly used in the infant population are briefly
described below but more detail can be found in the further reading list below.
Postural Drainage
Gravity assisted positioning (postural drainage [PD]), using various positions
to help drainage of secretions from particular areas of the lungs has
traditionally been a major component of physiotherapy treatment of infants
and young children with CF. The effects of gravity in enhancing airway
clearance are likely to be a result not only of drainage but also of a change in
distribution of ventilation. 5
More recently, the use of a head down tip during postural drainage has been
questioned due to concerns regarding gastro-oesophageal reflux. 2 Although
the use of postural drainage remains very common in the treatment of infants
and babies with CF, many centres no longer incorporate a head-down tip but
instead use a flat or slight head up positioning regimen (modified postural
drainage).
Percussion (chest clapping)
Chest percussion or clapping again has been a mainstay of physiotherapy
regimens in the younger CF population. Often combined with modified
postural drainage it aims to mobilise secretions and stimulate cough.
Percussion is generally well tolerated and is widely used in infants. It is
generally felt that is should be performed over a layer of clothing, using
“tented” fingers or a cupped hand. In very small babies the use of a soft
plastic cup shaped device (such as a face mask) may be helpful to
administrating the technique.
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