Mindful Airway Clearance for Cystic Fibrosis

I used to really struggle with using airway clearance devices like flutter and acapella.

I found I got restless. I got bored. I got distracted.

I could go months or years without using certain types of airway clearance equipment, because I just didn’t get on with it. I used different methods that were less reliant on breathing into a device. While we don’t have the vest readily available in the UK, I can understand why people choose this passive airway clearance technique.

The thing is, I have come to realise, over years of doing different types of physical activity and different types of breathing exercise, that breath awareness and an active breath (versus passive) is far more effective. I know this is something that CF physiotherpiasts will tell you (I've always been asked 'are you doing active breathing cycles?') but when you're honestly a bit bored and fed up with it all, it's totally understandable that you'd want to zone out and make it a passive activity, if at all possible.

I’m writing this because for the first time in years today, I decided to pick up my flutter and give it a go.

Why did I do this? And why did I find I was able to finally feel that I was able to do this effectively?

Why did I pick up my flutter for airway clearance?

When I use my pulmozyme neb and then do exercise, I find my airway clearance is alarmingly(!) effective. However, if I take a pulmozyme neb and do not properly clear it, I had signs that my lungs have become irritated. Since I like doing my pulmozyme nebuliser in the morning and have just enjoyed doing it in the sun of my garden, I wanted to find a way to clear it without having to get up from my comfy sun spot! So, I decided to revisit and old aid... my flutter device.

As you can maybe tell by this thought process, I’ve - over time - become mindful of what works for me, how my lungs feel and how my mind feels. This kind of mindfulness is what changes everything for me.

Without this mindful reflection, I would not have assessed what I truly needed. I would not have considered my options so thoughtfully. I would not have ended up with a flutter in my hand.

How did my flutter session differ from what I used to do?

I closed my eyes.

Maybe this was the biggest difference.

I wasn’t looking around the room (or garden, in my current case). I wasn’t watching TV. I wasn’t trying to read or check my phone.

I was able to focus entirely on me. And you know what? It felt like such a treat. To take that time to give myself some attention and focus and to do something kind for my body was awesome.

So, without all these distractions, what did I do?

I slowed down.

Rather than trying to rush out the prescribed 10-or-whatever breaths to feel like I had officially complete a cycle that would look good on paper at my next clinic appointment, I decided to let that go and just do what felt good for me.

I counted my in breath through my nose. I felt my tummy expand, my lower ribs, my sides, and up into my chest. 1... 2... 3... 4...

I allowed myself a pause at the top. Noticed how good it felt to have lungs full of air. Allowed that lovely air a chance to trickle into my smaller airways and to get behind anything that needed a helping hand being moved out of there. 1... 2... 3... 4...

And then I breathed out. I felt my cheeks stiff. I tried to focus on where I felt the vibrations from the flutter. And I counted. 1... 2... 3... 4... 5... 6... 7... 8...

And I did this maybe 5 times. And then I realised that my attention was starting to waver. Maybe I was getting a little impatient. Rather than force myself to continue in a way that would cause mental or physical tension, I paused. I took a little side bend stretch to really open up my side ribs. I breathed deeply to feel my ribs expand apart. And then I reset and did some more breaths with my flutter.

I did an assessment breath. And I followed with a round of autogenic drainage. I mixed it up for what I needed at the time. And I know that every day will be different. And if I remain aware of everything that I’m doing, I can mix up my airway clearance to serve me better.

Was this particular airway session more effective? It was. Because it was better than not doing it at all. It was better than had I not done it mindfully and let it become a stressor or burden.

By changing my mindset, it felt like an opportunity and a personal little self-care practise.

Even my other half has mentioned that when I’m doing my airway clearance or doing my nebulisers and focusing on my breath, it feels calming to him. Like a metronome of breathing. I love that it can have that knock on effect to other people’s state of mind too.

I know this form of AC isn’t as effective for me as my best exercise sessions so maybe I just need to be more mindful about combining them. New learnings and opportunities!

I really feel that aside from being taught how to use these devices in clinics and being given a prescriptive step-by-step, we should be taught mindfulness practices and breath awareness so that we feel properly connected to what we are doing and the effect that it has.

Questions to you

What allows you to make your airway clearance effective? How do you maintain your focus?

Are there any devices or airway clearance techniques that you haven’t touched in a while? What are they? Would you consider revisiting them?