Patient and Caregiver Perceptions of Airway Clearance Methods Used for Cystic Fibrosis

Abstract

Introduction: Cystic Fibrosis Foundation guidelines recommend people with CF perform daily airway clearance. This can be difficult for patients, as some find it time consuming or uncomfortable. Data comparing airway clearance methods are limited. We surveyed patients and their families to understand which methods are preferred and identify obstacles to performing airway clearance.

Methods: We designed a REDCap survey and enrolled participants in 2021. Respondents reported information on airway clearance usage, time commitment, and medication use. They rated airway clearance methods for effectiveness, comfort, time commitment, importance, and compatibility with other treatments. The analysis included descriptive statistics and clustering.

Results: 60 respondents started and 52 completed the survey. The median patient age was 20 years. Respondents experienced a median of four airway clearance methods in their lifetime, including chest wall oscillation (vest, 92%), manual chest physical therapy (CPT, 88%), forced expiration technique (huff or cough, 77%), and exercise (75%). Past 30-day use was highest for exercise (62%) and vest (57%). The time commitment was generally less than 2 hours daily. Of those eligible for CFTR modulators, 53% reported decreased time commitment to airway clearance after starting treatment. On a scale of 0-100, respondents rated CFTR modulators as their most important treatment (median 99.5), followed by exercise (88). Discussion. Patients and caregivers are familiar with several methods of airway clearance for CF. They report distinct strengths and limitations of each method. Exercise and vest are the most common methods of airway clearance. The use of CFTR modulators may reduce patient-reported time commitment to airway clearance.

Figure 1

(a) Association of current (past 30-day) usage of airway clearance methods with gender. Filled circles indicate the odds ratio for females using the indicated methods for airway clearance. Gray lines are 95% confidence intervals; the lower confidence interval for manual CPT is truncated. The number of respondents reporting use of each method is indicated. (b) Current age of patients using different airway clearance methods. Subjects with age >40 are indicated by triangles. There were no significant differences in age between airway clearance methods, Kruskal–Wallis test p=0.17.

Figure 2

Perceived importance of different therapies for cystic fibrosis as rated by patients or caregivers. Users scored a visual analog scale to rate the importance of different therapies. The default position of the slider was 50 on a scale of 0–100. Data points indicate individual responses; boxplots indicate median and quartiles. CFTR modulators were ranked as significantly more important than all other treatments. Exercise was rated more important than oral antibiotics, mucolytics, and other forms of airway clearance.

Figure 3

(a) Time commitment to CF treatments versus airway clearance methods and gender, N = 54 responses. Data points indicate total time estimated for treatments among respondents who used the indicated airway clearance methods at bottom. Some respondents reported current use of multiple methods. Vest users reported more time commitment to daily treatments. In a generalized linear model of time commitment by age category, gender, CFTR modulator use, and airway clearance method, vest usage was independently associated with the most reported time for treatments (p=0.0001). (b) Reported time commitment by age category among survey respondents. Age categories were defined as child (0–9 years), young adolescents (10–14 years), older adolescents (15–18 years), and adults >19 years. There was a trend toward lower median time commitment in older adolescent patients.

Figure 4

Heatmap display of patient/caregiver opinions of airway clearance methods. Users could rate positive attributes (a) or negative attributes (b) of any airway clearance method they had experienced. Colored are scaled by rows, with common responses indicated by darker colors. The number of responses is given in each cell.