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.