Physiotherapy in CF Flashcards
1
Q
What does physio for CF include?
A
- Airway clearance
- Inhalation therapy
- Exercise to maximise CR fitness, strength & bone density
- Advice on continence issues & pelvic floor exercises
- Thoracic mobility
- Postural advice
2
Q
What are the features of airway clearance in CF?
A
Commences at diagnosis
- Individualised
- Choice of modality depends on many factors (age, compliance, social factors, financial situation, severity)
- Techniques used separately or in combination
3
Q
What are the aims of airway clearance?
A
- Clear airway of secretions
- Improve ventilation
- Lessen effects of infection
- Avoid deterioration of breathing mechanics
- Preserve pulmonary function in the long term
- Improve QOL
4
Q
What airway clearance techniques are used in CF?
A
- Postural drainage
- Modified postural drainage
- Percussion/vibrations
- ACBT (blowing games)
- PEP (FRC focus)
- Oscillating PEP
- Autogenic drainage
- High frequency chest wall oscillation
- Interpulmonary percussive ventilation
- Exercise
5
Q
What are the precautions for coughing in CF?
A
- Repeated cough can damage airway walls
- Only clears central section of the lung
- Need ACT to get secretions from deeper lung segments up to be cleared by cough
6
Q
What does MCC require in CF?
A
- Adequate systemic hydration
- Cilia sit in layer of mucus, dehydration leads to sticker mucus & poor cilia function
- Second half of treatment really important for mucus that has to travel
7
Q
What are the features of inhalation therapy in CF?
A
1. Optimise timing with airway clearance • Pre-physio: bronchodilators, mucolytics, pulmozyme • Post-physio: antibiotics, pulmozyme 2. Equipment selection important - Use slow inspirations - Mouthpiece better than face mask
8
Q
What is dornase alpha?
A
- Enzyme that cuts up the strands of RNA released with cell death & found in thick sticky mucus
- Thins secretions
- Very expensive
9
Q
How should pulmozymes be timed with ACTs?
A
Absence of strong evidence to indicate that one timing regimen is better than another
10
Q
What has research found regarding hypertonic saline in CF?
A
- Improves FVC & FEV1
- Decreases infective exacerbation rate
- Decreases hospitalisation rate
- Safe to introduce in acute exacerbation for adults
11
Q
What is the role of Mannitol in CF?
A
- Sugar alcohol that acts as an osmotic agent
- Developed into bronchitol for use as a dry powder inhalation in the lungs
- Large RCT showed improvement in lung function following 6 months use
12
Q
What is a TOBI Podhaler?
A
- Option for delivering anti-pseudomonal antibiotic to the lungs
- Equal efficacy to nebulised solution
- 25% of the time, increased patient satisfaction, increased adherence, reduced exacerbations
13
Q
What are the benefits of exercise in CF?
A
- Improved CV fitness
- Improved muscle strength
- Improved QOL
- Improved core stability & thoracic mobility
- Improved prognosis
- Improved lung function
- Improve airway clearance
- Potential effect on bone mineral density & CF related diabetes
14
Q
What does exercise testing in CF involve?
A
- Regular testing recommended at leat anually
- Cardiopulmonary exercise testing (VO2 max)
- Field tests (6MWT, 3 min step test, modified shuttle walk test)
15
Q
What is the purpose of exercise testing in CF?
A
- Measure of disease severity/progress
- Assist in exercise prescription
- Quantify level of exercise limitation
