Cystic fibrosis physiotherapy and exercise

In cystic fibrosis, mucus in the airways is thick and sticky and is hard to move, which encourages infection and inflammation. Asthma + Lung UK says airway clearance techniques can help you loosen and clear mucus from your lungs and that they form a cornerstone of daily management, potentially reducing infection risk and improving lung capacity.

The same group of techniques is used in other conditions with excess phlegm, such as bronchiectasis, so many of the methods are familiar to respiratory physiotherapists.

The NHS says a physiotherapist can teach you ways to improve your breathing and posture to help clear mucus from your lungs, and that devices such as inhalers and specially designed masks can also assist. Asthma + Lung UK describes respiratory physiotherapists as part of a multidisciplinary team alongside dietitians and physicians.

The physiotherapist assesses you, chooses a technique that suits your age and lung condition, checks your technique and adjusts the routine over time. Children are taught with their families, often through play and games.

Techniques that are widely used across lung conditions include the active cycle of breathing technique, which alternates relaxed breathing, deep breaths and huffing, and hand-held oscillating positive expiratory pressure devices that use vibration and air pressure to move phlegm upwards, as described by Asthma + Lung UK in its general airway clearance guidance.

Your cystic fibrosis physiotherapist may select other techniques, positions or equipment, and may recommend a nebuliser before clearance. Never change the routine without discussing it, as some methods are unsuitable at certain times.

• Do clearance at the times agreed with your team, usually with consistency day to day.

• Clean and maintain devices as instructed to reduce infection risk.

• Tell your team if you notice more phlegm, blood in the phlegm or new breathlessness.

The NHS advises people to stay as physically active as possible because it can help clear mucus from the body. Asthma + Lung UK says keeping active helps your lungs work better and can make airway clearance techniques easier to do.

Walking, cycling, swimming, running and sports are all options, and many people also benefit from strength work for posture and bone health. Your physiotherapist can suggest a programme and advise on drinking and eating around exercise, since people with cystic fibrosis often need extra salt and fluid in hot conditions.

The NHS says after diagnosis you will usually be referred to your nearest NHS cystic fibrosis care team made up of various healthcare professionals, usually based in larger NHS hospitals. Asthma + Lung UK describes coordinated monitoring and personalised treatment plans from a multidisciplinary team.

Beyond physiotherapy, the NHS lists CFTR modulators that improve lung function, bronchodilators to widen airways, antibiotics for infections and anti-inflammatory steroids, with lung transplant considered in severe cases. Asthma + Lung UK says modulators target the underlying genetic mutation rather than just symptoms.

Contact your cystic fibrosis team promptly for more coughing or phlegm, a change in phlegm colour, new breathlessness, fever, weight loss or reduced exercise tolerance, rather than waiting for the next review. Many centres have a nurse helpline for exactly this.

Call 999 for severe breathlessness, coughing up a significant amount of blood or chest pain with collapse.

The NHS says cystic fibrosis currently has no cure and can shorten life, but that new treatments mean symptoms can often be managed and many people diagnosed today will live well past middle age.

The daily routine takes time and can feel burdensome. Ask your team about ways to fit it around school, work and family, and about peer support and mental health services, which centres can arrange.