(266) Airway Clearance Therapy: Experiences and Perceptions of Adults Living with Cystic Fibrosis

Background: Routine airway clearance therapy (ACT) is a cornerstone treatment of cystic fibrosis (CF). However, difficulties adhering to ACT is a common issue and is associated with poorer health outcomes. There are no known differences in treatment efficacy among different ACT techniques; thus, understanding patients’ experiences and perceptions of ACT may help clinicians to provide individualized recommendations of ACT techniques. This study aims to explore patients’ experiences and perceptions of different ACT techniques and how they influence ACT selection in adults living with CF.

Methods: This is a qualitative descriptive study conducted using individual, audio recorded, semi-structured interviews. Participants were recruited from Toronto Adult CF Center, St. Michael’s Hospital, Unity Health Toronto. Eligibility criteria included being ≥18 years of age, a childhood CF diagnosis, no history of lung transplant, and in stable condition. Demographic and clinical variables were collected. Using a purposive sampling strategy, we aim to recruit 10 to 15 participants with varied age, sex and levels of lung function. Audio recordings were transcribed, coded, and analyzed for emerging themes and patterns.

Results: Interviews with four participants were conducted to date [27-52 years of age; 3 males; all were on modulator therapy]. Participants shared their experiences of ACT, its role in daily life and self-management routines, and what prompted the use of one ACT technique over another. Our preliminary analysis has identified four key themes: 1) the intensive work of CF self-management; 2) factors informing ACT technique selection; 3) perceptions of treatment effectiveness; and 4) the impact of social support. Participants recounted the intensive work entailed in CF self-management, including the significant amount of time and self-discipline to integrate into daily routines alongside medications and work schedules. Many factors informed ACT technique selection i.e. convenience, comfort, discretion, time-efficiency, and whether the technique was supported by research evidence. Most participants indicated a preference for “active” and “independent” techniques which they could perform without reliance on others, such as positive expiratory pressure and autogenic drainage. “Passive” techniques such as manual ACT techniques, e.g. percussion, were typically reserved for periods of exacerbation and hospitalization for energy conservation. Participants also commented on how they determined the technique's effectiveness such as the amount of mucus cleared, noticeable improvements in lung function, symptom relief, and no side-effect of bronchospasm. Finally, social supports were described as playing a role in treatment adherence. Some recounted that positive parental support helped normalize ACT use, and that support from healthcare providers helped provide accountability towards treatment adherence.

Conclusions: In addition to factors associated with different ACT techniques i.e. convenience, discretion, energy demands, this study found that the interaction between ACT techniques, the patients’ life and social environment were important factors that influenced patients’ choice of ACT technique. Future studies may explore the importance of taking a thorough subjective history to identify individual factors pertaining to ACT technique selection and explore how attending to these factors may help with treatment recommendations and adherence.

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