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Airway clearance is considered an integral component of the management of cystic fibrosis (CF). Recent CF pulmonary guidelines made recommendations using the US Prentative Service task Force (USPSTF) grading scheme (a system which provides a mechanism to weigh the quality of evidence and the potential harms and benefits) on airway clearance.1 2 These guidelines recommended that airway clearance should be provided to all patients with CF (grade B recommendation: high certainty that the net benefit is moderate and at least moderate certainty that the net benefit is moderate to substantial).1 They also summarise the evidence for the efficacy of one airway clearance regime versus another and recommend (grade B) that no airway clearance regime has been shown to be superior to others although they recognise that, for any individual, one airway clearance regime may be superior. They advocate that patients should be able to choose, in collaboration with the therapist, which airway clearance regime/regimes they wish to use. Other guidelines and systematic reviews as well as many primary trials agree that there is no clear advantage of one particular airway clearance regime over another.3
The active cycle of breathing techniques (ACBT) is the standard airway clearance regime in the UK, although in the last few years other forms of airway clearance (eg, autogenic drainage) as well as a range of adjuncts have become popular (eg, positive expiratory pressure (PEP) mask, flutter and Acapella). These adjuncts are often provided “free” at the point of delivery to the patient within the current healthcare system. In the USA, high frequency chest wall oscillation (HFCWO; known as the Vest) is widely used and is purchased for patients under various insurance schemes. HFCWO is not widely provided to patients with CF in the UK or the Republic of Ireland, and patients who …
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