Thursday, October 24, 2013

Effective Airway Treatment & The CLAMP Motto

What does an effective airway treatment look like to you? I think we are all guilty of an ineffective airway treatment at least once in our life.  I know I am.  I have fallen into the ineffective airway treatment more than once!  But lately I have been paying close attention to my airway treatments because I want to get the most bang for my buck!  Who doesn’t want to get the most out of their airway treatment?  I think we all can answer that during the time we are hooked up to that machine that shakes us we want the most effective form of airway treatment.  There are many things we need to remember when we are tethered to that vest machine. Hopefully, this blog will help some of you get the most bang for your buck when it comes to treatment time.

When it comes to airway clearance how many of you have actually been told how to properly vest????  I wish I could see a show of hands : )  I am guessing that not many of us have been given an actual lesson in airway clearance. My hand would be down as well so don’t feel bad.   For me, I can remember that day I got my vest machine from hil rom (I use the hil rom 105 model).  Before ordering the vest, I sat down with the respiratory tech at my clinic and she just let me try out the machine.  She said you can change the pressure, the frequency and it has a timer.  I was told to just do 5 minute intervals for a total of 15 minutes.  In between 5 minute sets, she said just make sure to cough.  Uhm ok that was about all the training I ever received for using the vest. 

The other day, I was reading on Facebook about an actual airway clearance technique called the Minnesota protocol. I am not promoting this technique just making you all aware of it.  I honestly think this is the best way to use our vest but I suggest playing around with the settings that best fit your lungs! 

At first, I have never even heard of this protocol.  After reading the link, it was clear to me that I have been basically doing this protocol.  Here is how I have been vesting for the last 10 years of my life.  I do 5 min intervals of each while nebbing HTS (I started HTS about 1.5 years ago, and you all know I LOVE IT) and I always make sure to huff cough and get the mucus out during the PAUSE.  I start out at 8hz/7 pressure, 12hz/7 pressure, 16hz/7 pressure, and 18hz/7 pressure.  By the time I hit the 18 hz setting I am coughing a ton of mucus out.    I think the biggest thing in the protocol is LUBRICATION (nebulizing) and taking a PAUSE to cough.  It is so important to cough in between frequency changes while vesting even if we need to make our self cough.  That will help loosen up the mucus!!!

After I read the article on the protocol, I developed my own acronym CLAMP.   Here is what it means and not in any specific order.  But we should all focus on these while doing our airway treatments.  

Lubrication (nebulizing)
Air (breathing)

LUBRICATION (nebulizing) – Without oil or LUBRICATION in any machine the parts get stuck together and they do not move very well. Think about your car or any other piece of equipment that is heavy duty.  Our lungs are the same way especially in CF.  The lungs of CFers are not sufficiently hydrated enough which causes mucus to just keep on building up.  So if we are not properly LUBRICATING our lungs then the mucus will just stick around and keep building on top of mucus thus making it more likely for us to have infections.   That is why it’s so important to be nebulizing hypertonic saline or another aerosol to help LUBRICATE the lungs.  The more LUBRICATION we have in our lungs the more likely we will be able to cough out the mucus.   So lube up those lungs!!

AIR (breathing) – I think we all suffer from the proper BREATHING technique during airway treatments.  How many of us get distracted with facebook, blogger, emailing, music, reading, or tv?  I know I fall into this boat.  I find myself not taking in deep breaths and holding or even slouching during treatment.   We should be focused on sitting up straight and inhaling and exhaling effectively.  If we are not doing this we will not allow the aerosolized neb to fully reach or lungs.

I noticed lately that I have been focusing a lot more on my BREATHING and have seen an increase in the effectiveness of my airway treatment. More mucus has been coughed out and I just feel cleaner lung wise.   So the next time you are vesting/nebbing make sure you are thinking about proper BREATHING and posture.  We don’t want to sell our self short during treatment because of a lazy BREATHING or posture habit.

PAUSE & COUGH – I know there are people out there who have programmed their hil rom vest to their current settings and do not take a PAUSE in between the next frequency change to COUGH.  In the Minnesota protocol the PAUSE and COUGH is really emphasized.  The reason we are all suppose to PAUSE in between the next frequency change is to COUGH.  In order to move that mucus out or around we need to physically make our lungs push out the mucus.  I know that some people just will cough when they have the feeling to cough during treatment.  I think for a fully effective airway treatment we need to focus on the PAUSE.  We should give our self a full minute to sit with no neb in our mouth or vest shaking us to death to just COUGH.  Try to use the huff cough, flutter, acapalla, or whatever it is that makes you COUGH.  

I have incorporated the PAUSE into my airway treatment since I began vesting and I can tell that I am moving mucus!!  I can remember when I had my gall bladder removed my doctor told me there is no point in doing airway clearance if you are not coughing.  So incorporate the PAUSE and the forced COUGH into your airway treatment even if it makes you uncomfortable.  I think you will be glad you did. 

MUCUS – When it comes to CF we all have MUCUS in our lungs. It’s just a given aspect of the disease.  Even when we feel 100% and are not suffering from a CF exacerbation we will always have MUCUS.  That statement is according to my doctor.  I asked him if I will never have mucus and that was his response. 

You may feel that if you are not coughing out any MUCUS during your airway treatment that you are feeling really healthy.  I agree to a certain extent but I honestly would rather cough out MUCUS in every single airway treatment.  That for me reassures me that this airway treatment stuff is really doing its job. If you are not coughing out any MUCUS maybe you need to focus on your breathing technique, posture, or even question if you should be doing an extra aerosolized medicine.    

In my evening treatment, I noticed that I was not as productive when it came to moving that MUCUS out.  So I questioned my doctor about adding HTS in the evening.  I was only taking HTS 7% in the morning and noticed that I was clearing mucus left and right from adding this neb.  For me, my lungs were not lubricated enough during my evening treatment. We added HTS 3% to my evening treatment and it has changed the effectiveness of my airway treatment.  I am now coughing more mucus out in the evening than I ever did before!!

The more mucus we are clearing out the less there is to deteriorate our lungs and grow infection.  So get to moving that MUCUS out!! 

I understand every CFer is different when it comes to an effective airway treatment.  Those are just a few things that I think we all can focus on during airway treatments.  Even if you do not do the Minnesota protocol you should still think of the CLAMP motto every time you CLAMP that vest on you!!

Also, for all the parents of CFers who read my blog I suggest getting your children in the habit of an effective airway treatment.  You need to reassure the youngsters to focus on their breathing/posture, take a pause to cough, encourage them to get that mucus out, and to effectively nebulize.   It’s easier to get into an effective routine when you are young!  At least that’s how I feel. 

I hope that this has helped at least one person out there get the most bang for their buck when it comes to airway treatments.  If you have other effective airway treatment methods please share them!  WE ARE ALL IN THIS TOGETHER!!! 



  1. My computer was out of commission for all of October so I am just catching up on blogs now. Thanks for the reminder of proper airway clearance, I find I can get distracted (internet, blogger, etc) and get lazy with my Vest. There is no point in doing airway clearance if you aren't doing it correctly!

  2. John, loved this post. I will concentrate on my airway treatments and posture. I am falling into the habit of reading and browsing my iphone. You are an enthusiastic and inspirational CF'er. Keep up the blogs. I am feeling much better since we last chatted. I find a good diet and exercise adds to to the results from vest treatments/nebs.....drmuller from cfconnect

  3. Thank you so much for sharing this! I have shared it with my 13 year old daughter, she is still compliant with doing her treatments, but argues with me when it comes to protocols like this while actually doing the treatment.