These Master Classes in physiotherapy are brought to you by Child Health International in collaboration with the Association of Chartered Physiotherapists in Cystic Fibrosis and the European Cystic Fibrosis Society’s Physiotherapy Specialist International Interest Group, in association with the Cystic Fibrosis Trust.
The classes are intended as training material for medical professionals only. We do not recommend their use by patients, or by parents or guardians, without proper medical advice and supervision.
Click on the relevant lesson for more information and to access full lesson content
2. Physiotherapy for Infants and Toddlers Under 4 Years Old with Cystic Fibrosis
Lesson 2.1 – Child Assessment and Treatment
This lesson teaches how to be:
- Confident in the respiratory assessment of a child under 4 years old;
- Able to formulate an effective airway clearance program for the child and their family;
- Confident in the knowledge of different Airway Clearance Techniques (‘ACT’) for those children; and
- Able to effectively teach different ACT’s to the parents of children under that age
Lesson 2.2 – Positioning/modified postural drainage positions
(This is only suitable for children greater than 6 months old)
(This is only suitable for children greater than 6 months old)
This lesson explains how to use different positions to improve ventilation and airflow in different areas of the lungs and how gravity is utilised to help move secretions from peripheral to larger airways.
Lesson 2.3 – Positive Expiratory Pressure (PEP) for Infants
This lesson explains how PEP therapy works by creating a small amount of resistance through a small hole when the baby breathes out. The expiratory pressure created helps to hold the airways open and get air behind any secretions. This helps to move the secretions centrally and helps the infant to clear them.
Lesson 2.4 – Bubble PEP for Infants 2.5 years old and older
This lesson shows how a low pressure PEP circuit can be made using a 2 pint/ 1L bottle filled with water to a depth of 10-15cm and an 8mm diameter tube.
This again helps to open up their airways in the same way as a PEP mask. It also allows the child to be more independent as they get older.
Lesson 2.5 – The benefits of Exercise and examples
Exercise is very important for cystic fibrosis children and consequently, should be encouraged everyday throughout life, starting as a baby.
This lesson focuses on encouraging young babies to exercise, move and actively play, to take bigger breaths which improves air flow to different parts of the lungs. It also helps to move any mucus in their chest.
Additional Resources
See below for links to patient advice leaflets freely available to access online:
- Airway clearance for babies and young children with cystic fibrosis: A leaflet produced by the CF Trust in the UK on airway clearance for babies and young children is available at INF18-J – Airway_clearance_for_babies_young_children_v3_web.pdf (cysticfibrosis.org.uk)
- Bubble PEP: A leaflet produced by the CF Trust in the UK on Bubble PEP is available at Bubble PEP Jan 2018.pdf (cysticfibrosis.org.uk)
3. Physiotherapy for Children Aged 4-12 Years with Cystic Fibrosis
Lesson 3.1 – Active Cycle of Breathing Technique (ACBT)
ACBT is a cycle of breathing control, thoracic expansion exercises (bigger deep breaths), and forced expiration technique (huffing). This lesson explains what a treatment session should look like and how the cycle can be adapted depending on the patient’s needs.
Lesson 3.2 – Positive Expiratory Pressure (PEP)
Unlike lesson 2.3 where the PEP mask is applied by the parent or physiotherapist, this lesson explains how the patient should use the mask or similar devices themselves.
Lesson 3.3 – Oscillating PEP (OPEP)
This lesson explains the use of an OPEP, which is suitable for patients with retained secretions that can be hard to clear. Note that the patient must be old enough to understand instructions and create and maintain a good seal around the mouthpiece without allowing their cheeks to ‘puff out’.
Additional Resources
See below for links to patient advice leaflets freely available to access online:
- Active Cycle of breathing Technique (ACBT): A leaflet produced by the CF Trust in the UK on Active Cycle of Breathing Technique (ACBT) is available at ACBT leaflet Mar 2018.pdf (cysticfibrosis.org.uk)
- Positive Expiratory Pressure (PEP): A leaflet produced by the CF Trust in the UK on Positive Expiratory Pressure (PEP) is available at How to use a PEP mask leaflet Mar 2018.pdf (cysticfibrosis.org.uk) and PARI PEP leaflet Jan 2018.pdf (cysticfibrosis.org.uk)
- Oscillating PEP: A leaflet produced by the CF Trust in the UK on Acapella is available at Acapella leaflet Jan 2018.pdf (cysticfibrosis.org.uk)
4. Physiotherapy for Children Aged 12+ Years with Cystic Fibrosis
Lesson 4.1 – Autogenic Drainage (AD)
A cough only clears mucus from the larger airways. AD is useful to move mucus from areas where it might be stuck deeper in the lungs and consists of a series of breathing exercises that will help the patient clear their mucous with as little effort as possible.
This lesson shows how to teach the patient to make changes to their breathing to increase the movement of air in their airways to move mucus from the smaller airways, up into the larger airways so it can be cleared.
Lesson 4.2 – Transition
This lesson covers Transition: the process of moving from paediatric to adult services.
This process can take 2 to 3 years with planning starting when the young person is 13 or 14 years old. It involves moving from a parental type relationship to a “partnership” which enables the young person with CF to have more responsibility for decision making about their care.
However, in countries where adult services are scarce, this may not be possible and consequently, some clinicians will need further assistance with the management of the young adult. This is where Child Health International may be able to assist with help and advice.
Additional Resources
See below for links to patient advice leaflets freely available to access online:
- Autogenic Drainage (AD): A leaflet produced by the CF Trust in the UK on Autogenic Drainage (AD) is available at Autogenic_drainage factsheet.pdf (cysticfibrosis.org.uk)
- Transitioning to adult care:
Guidelines & Consensus Documents Available Online
- Standards of Care and Good Clinical Practice for the Physiotherapy Management of Cystic Fibrosis (2020) Fourth edition – December 2020 Standards of Care and Good Clinical Practice for the Physiotherapy Management of Cystic Fibrosis Fourth edition December 2020.pdf
- Standards for the Clinical Care of Children and Adults with cystic fibrosis in the UK Second edition. December 2011 Cystic Fibrosis Trust Standards of care.pdf
- NICE Quality Standards: Cystic Fibrosis May 2018 Cystic fibrosis (nice.org.uk)
- Guidelines for the physiotherapy management of the adult, medical, spontaneously breathing patient Joint BTS/ ACPRC guideline. Thorax May 2009 untitled (acprc.org.uk)
- ECFS Best Practice Guidelines (2014) https://www.cysticfibrosisjournal.com/article/S1569-1993(14)00085-X/fulltext
- ECFS Best Practice Review (2018) https://www.cysticfibrosisjournal.com/article/S1569-1993(18)30029-8/fulltext
- Physiotherapy for People with Cystic Fibrosis: from Infant to Adult (2019) IPG CF_Blue Booklet_7th edition 2019 (ecfs.eu)


