Cystic fibrosis pulmonary guidelines: Airway clearance therapies

Patrick A. Flume, Karen A. Robinson, Brian P. O'Sullivan, Jonathan D. Finder, Robert L. Vender, Donna Beth Willey-Courand, Terry B. White, Bruce C. Marshall, Janet Bujan, Anne Downs, Jonathan Finder, Chris Goss, Leslie Hazle, Mary Lester, Bruce Marshall, Peter Mogayzel, Lynne Quittell, Randall Rosenblatt, Kathryn Sabadosa

Research output: Contribution to journalReview articlepeer-review

238 Scopus citations


Cystic fibrosis (CF) is a genetic disease characterized by dehydration of airway surface liquid and impaired mucociliary clearance. As a result, there is difficulty clearing pathogens from the lung, and patients experience chronic pulmonary infections and inflammation. Clearance of airway secretions has been a primary therapy for those with CF, and a variety of airway clearance therapies (ACTs) have been developed. Because ACTs are intrusive and require considerable time and effort, it is important that appropriate techniques are recommended on the basis of available evidence of efficacy and safety. Therefore, the Cystic Fibrosis Foundation established a committee to examine the clinical evidence for each therapy and provide guidance for their use. A systematic review was commissioned, which identified 7 unique reviews and 13 additional controlled trials that addressed one or more of the comparisons of interest and were deemed eligible for inclusion. Recommendations for use of the ACTs were made, balancing the quality of evidence and the potential harms and benefits. The committee determined that, although there is a paucity of controlled trials that assess the long-term effects of ACTs, the evidence quality overall for their use in CF is fair and the benefit is moderate. The committee recommends airway clearance be performed on a regular basis in all patients. There are no ACTs demonstrated to be superior to others, so the prescription of ACTs should be individualized. Aerobic exercise is recommended as an adjunctive therapy for airway clearance and for its additional benefits to overall health.

Original languageEnglish (US)
Pages (from-to)522-537
Number of pages16
JournalRespiratory care
Issue number4
StatePublished - Apr 1 2009


  • Active cycle of breathing
  • Airway clearance
  • Autogenic drainage
  • Cystic fibrosis
  • Exercise
  • Guidelines
  • High frequency chest wall compression
  • Oscillating pep
  • PEP
  • Systematic review

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine


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