4 Discussion
In this population, patients with CF or their caregivers were familiar
with several forms of airway clearance and reported ~1
hour of daily time commitment to these therapies. Those receiving CFTR
modulators reported decreasing their airway clearance, and some
respondents reported performing little (< 30 minutes per day)
airway clearance.
While respondents were familiar with many forms of airway clearance,
their past 30-day usage indicated preference for exercise, followed by
vest, huff coughing and PEP devices. Male and female patients used each
of the airway clearance forms roughly equally, but there were trends
towards greater vest usage in females and exercise in males, which is
consistent with observations in prior studies.24,25Although we hypothesized there would be difference in airway clearance
practices by age group, children, adolescents, and adults reported
similar use of airway clearance methods and overall time commitment. The
lack of significant differences between age categories in time spent on
airway clearance could be related to the relatively small sample size in
this study. The most important contributor to time spent on airway
clearance in our cohort was the use of a vest device.
Whether exercise is an acceptable substitute for traditional airway
clearance remains controversial.6,26-28 Exercise is
common in patients with CF, and many patients either incorporate
exercise into their airway clearance or use exercise as a replacement
for traditional airway clearance.26 Exercise may
improve ease of expectoration and sputum clearance and may have similar
effects to traditional airway clearance in the short
term.29 Some advocate the use of exercise as airway
clearance in part because exercise is more easily accepted by society,
which helps to normalize the lives of patients with
CF.28 However, others contend that traditional airway
clearance techniques are still the superior method for mucus
clearance.27
Despite the inherent challenges of exercise and airway clearance, many
respondents considered these therapies important for maintaining their
health. However, it remains unclear which forms of airway clearance are
optimal for patients with CF. Many studies suggest no method of airway
clearance is superior to others.29-31 Even within a
class of airway clearance treatments, there is significant variability.
For instance, there is no clear evidence that one type of oscillating
PEP device is superior to another.30 Patients with CF
or their caregivers may wish to use airway clearance techniques that
best meet their individual needs, after considering comfort,
convenience, flexibility, practicality, and cost.31
4.2 Advantages
An advantage of this study is that our survey compares airway clearance
methods from the patient perspective. This could provide better
understanding of why some methods are preferred by patients. Knowing how
patients think or feel about airway clearance methods could help
clinicians understand potential barriers to using airway clearance,
including pain or discomfort, time commitment, and perceived lack of
efficacy. This study also compares the importance of airway clearance
relative to medications and other CF therapies from the perspective of
the patient. This information may help the CF research community plan
future studies aimed at simplifying CF care plans.
4.3 Limitations
Because this study was voluntary, there is some risk of selection or
responder bias. The study was anonymous and used self-reported time
commitment. Thus, we could not confirm the time spent on airway
clearance by an independent objective measure. Finally, this was a
single-center study, which potentially limits generalizability to other
centers or to populations with lower eligibility for CFTR modulator
treatments. However, the distributions of age, gender, CFTR theratypes,
and pulmonary function among survey responses were similar to our recent
reports.32,33 Thus, the results of this survey are
likely to be representative for our center.
4.4 Implications
Patients with CF are familiar with several methods of airway clearance.
In this study, people with CF or their caregivers consider CFTR
modulators more important than airway clearance, and respondents
receiving these drugs report decreased time spent for airway clearance.
Additionally, our survey indicates people with CF and their caregivers
prefer some methods of airway clearance over others and may consider
exercise as an adequate replacement for traditional forms of airway
clearance. Despite this, people with CF still consider airway clearance
important for maintaining health.