Researchers compared airway clearance therapies in cystic fibrosis patients using specific cough technique (SCT) and forced expiration technique (FET).  

By Lisa Spear

We know that airway clearance is a fundamental part of the treatment regimen for cystic fibrosis patients, and effective mucus clearance is essential to reduce symptoms, lessen inflammation, and prevent infection; but it is also thought of as one of the most burdensome and time-consuming aspects of the cystic fibrosis treatment regimen.1-2

It’s difficult for patients and clinicians alike to measure how much airway clearance psychotherapy is enough to optimize improvements in health-related quality of life. A new research study, published in Plos One, aimed to explore this area.3

The secondary analysis of a prior clinical intervention study in airway clearance physiotherapy (ACP) included six adults. The study looked at eight weeks of therapy, twice a week, using saline inhalation in horizontal positions, one with specific cough techniques and one with the forced expiration technique, in random order.

Success of the treatment was determined by sputum weight after each session. The patients also reported their perception of the therapy and how useful it was. Lung function was assessed at baseline.

The researchers found a significant correlation between total sputum weight in grams and the positive changes in health-related quality of life respiratory symptoms scores, and between the changes in lung function and the health-related quality of life respiratory symptoms scores.

“By emphasizing sputum removal, respiratory symptoms and health perceptions improved. In addition, the improvement in respiratory symptoms was associated with lung function,” said coauthor Sandra Gursli, a physiotherapist at Oslo University Hospital in Oslo.

The airway clearance intervention was associated with clinically meaningful changes in patient-reported symptoms in health-related quality of life for the majority of the participants, the researchers concluded.  

The study found that ACP had an effect on HRQoL with clinically relevant changes in respiratory symptoms scores in the majority of the participants, clearly exceeding MID ≥ 4 p, and with a positive change in the CFQ-R Health Perceptions scores in all research subjects, explains Gursli.

“A strong correlation was found between the clearance of mucus from the airways (total sputum weight) and positive changes in CFQ-R-RSS, and between changes in lung function (FEF50) and CFQ-R-RSS before and after completed intervention,” said Gursli.

In a more extended analysis, it was found that sputum weight alone explained the improvement in HRQoL. In addition, results show a linkage between different types of outcomes and a relationship between clinical variables and HRQoL.

“This finding warrants further investigation regarding treatment, duration and frequency. A long-term study may reveal beneficial effects on other clinically meaningful endpoints, such as pulmonary exacerbations, high-resolution computed tomography scores and [health-related quality of life],” the researchers wrote.


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  1. Fahy JV and Dickey BF, Airway mucus function and dysfunction. New England Journal of Medicine, 2010. 363(23): p. 2233–2247.
  2. Royce FH and Carl JC, Health-related quality of life in cystic fibrosis. Current Opinion in Pediatrics, 2011. 23(5): p. 535–40. pmid:21900781
  3. Gursli S, Quittner A, Jahnsen RB, Skrede B, Stuge B, Bakkeheim E. Airway clearance physiotherapy and health-related quality of life in cystic fibrosis. PLoS One. 2022 Oct 18;17(10):e0276310.