Master Classes in Physiotherapy (format b)

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 Special 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


Lesson 1.1 – 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 – Positioning/modified postural drainage positions 

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 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 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 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. 


Lesson 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 2 – Positive Expiratory Pressure (PEP) 

Unlike lesson 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 – 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’.  


Lesson 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 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.  

Further information is available through our library of online resourses