Technique | Advantages | Comment/disadvantage |
Directed cough | Inexpensive, simple | Chest pain may limit |
Regular exercise | Inexpensive, strengthens respiratory and peripheral muscles | |
Autogenic breathing | Controls breathing | Requires patient cooperation |
Forced expiration | Helps control breathing | Requires patient learning |
Chest physical therapy (CPT; postural drainage, hand, or mechanical chest clapping) | Most tested in cystic fibrosis | Needs assistant, hard to position, hypoxemia, sometimes worsens gastroesophageal reflux |
Positive expiratory pressure (PEP) | Easy, inexpensive | Device needs cleaning |
Oscillatory PEP (eg, flutter valve acapella device) | Easy, inexpensive, adds vibration to airways | Device needs cleaning |
High-frequency chest wall oscillation vest with inflatable bladder | Extensive experience | Pain may limit; need electrical outlet |
High-frequency chest wall oscillation vest with mechanical oscillators | Not painful compared with inflatable bladder | Can be mobile; small batteries in the vest; closest to CPT |
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