Thus, management included breathing exercises, gentle fixation
techniques and the use of oscillatory positive pressure devices
(Aerobika, Trudell medical, Pari O-Pep); Also, patient B’s non-invasive
ventilation device and soap bubble games. In addition, mild lower
extremity exercises: treadmill, steps and stationary bicycle.
Patient A, following initial respiratory improvement was discharge and
continued outpatient treatment. Outpatient physiotherapists were
instructed regarding the required management and a senior
physiotherapist from our CF center remained in constant communication.
Patient B, suffered several episodes of mild hemoptysis which resolved
spontaneously, without requiring treatment modification.
The treatment framework was followed until the DVTs resolved
radiologically. Neither patient suffered from PE, both maintained their
respiratory condition.
To conclude, we report our experience regarding physiotherapy management
in two patients with CF and severe lung disease who were diagnosed with
upper limb DVTs.
To our knowledge, there are no existing guidelines nor expert opinion.
This is especially relevant in patients with a more severe disease.
We present a framework established following a multidisciplinary
discussion. This framework includes a set of simple instructions easily
communicable. Adhering to these instructions enabled us to maintain our
patients’ respiratory status without any major adverse events.
Since physiotherapy is standard treatment in all patients with CF, and
especially during pulmonary exacerbation, and since DVT is not an
uncommon complication and poses an increased risk for both pulmonary
emboli and hemoptysis: specific guidelines are required for management
of patients with CF suffering from upper and lower limb DVTs.