Commentary on "Autogenic Drainage in Children With Cystic Fibrosis".

Abstract

“How could I apply this information?” Cystic fibrosis (CF), a disease that begins at conception, is not considered just a disease of childhood. People with CF are living well into adulthood and have options for living long, fulfilling lives. However, the pulmonary complications of the disease mandate that individuals must regularly clear secretions from their lungs to minimize infections that lead to lung function decline. Airway clearance techniques of many types have been the mainstay of pulmonary treatment for generations. Although research has attempted to determine the optimal technique, these techniques are shown to be equivalent to each other in outcomes such as sputum clearance, pulmonary exacerbation rates, or rate of lung function decline. The authors of this systematic review found similar results in children as have been shown many times in the adult population. This systematic review gives clinicians confidence that autogenic drainage can be effective and may be preferred by some children to postural drainage with percussion. “What should I be mindful about when applying this information?” Because clearing the lungs must be performed daily, there needs to be a variety of techniques available to patients and families to adapt for the differences each day, such as availability of help, comfort, energy required, skill level in performing a technique, conditions of illness or good health, at home or away, active participation or passive, concomitant health issues, social support, and financial resources. We also feel, contrary to the authors, that autogenic drainage has proven its safety by lack of adverse events noted in the key, well-designed studies they cite. Although the authors conclude it may be useful to teach this technique to children older than 8 years, we caution clinicians to assess the maturity and readiness to learn of each individual with CF to help determine the best timing and variety of airway clearance techniques to recommend. Anne K. Swisher, PT, PhD, CCS, FAPTA West Virginia University Morgantown, West Virginia Karen von Berg, PT, DPT Johns Hopkins Hospital Baltimore, Maryland