Airway clearance/bronchial hygiene

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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