Chest percussion physio and Covid

[quebec]

My teen has bronchiectasis and I do chest percussion to loosen mucus and aid airway clearance each night. They were on shielding list and have now been told they can unshield and return to school as young people don’t get severe cases of Covid. Young people are more likely to have asymptotic infections. I am on a shielding letter for an autoimmune condition and am avoiding exposure to the virus. Chest percussion involves close contact as you tap their chest and lots of huffing and coughing which would spray viral particles into the air. This would vastly increase my risk of infection. How can my teen clear their chest without chest percussion? There is no one else in the household who can safely take on this role.

[Misemob]

Your teen could perhaps try an an Acapella or aerobika device to clear instead. Personally, I find the later easier. A physio would need to instruct on its use and then your teen can use it them self, independently of others. Hope this helps.

[Hidden]

Your teen should be clearing his chest himself by now, using breathing and expelling tecniques which rule out the need to have percussion performed on his chest. I have had bronch all of my life (70 now) and have done my own clearance since I was very young. In fact, on the few occasions that I found myself in hospital for antibiotic treatment, and was ‘helped ‘ by physios doing that on me, it was less effective than doing it myself.

I am useless at posting links but hopefully someone can come along who can post the links to the active cycle of breathing, which loosens the mucus and huffing and expelling tecniques. I also do exercise and find bending forward and swinging my arms from side to side whilst doing the breathing is also very effective at moving it.

Your son can work out how many times each day he needs to do this to be comfortable.

I hope that helped

[cofdrop-UK]

Hi quebec,

I am so sorry your daughter has bronchiectasis and sorry too that you have an autoimmune condition.

Like Littlepom I too have had bronchiectasis from babyhood and from late adulthood asthma. I too had postural draining and percussion administered on me during my numerous hospitalisations as a child.

As an older child and teenager I was doing my own lung clearance using this method (it was the only method we had) and I have an arrangement with my physio that I do it in the morning but do Active Cycle of Breathing at night because of reflux.

It sounds as if your daughter has been diagnosed more recently and I fully understand, as a mum, you want to help your daughter as much as you possibly can. Both for your sake with your own health issues and that of your daughter’s I feel it is important that she learns as much as she can about bronchiectasis and lung clearance. She will learn not to be defined by her condition, will give her the confidence to manage her bronchiectasis (BE) and will stand her in good stead when discussing her health with clinicians, where unless specialised in BE, she will need to be ‘in the know’.

Not sure if she is still under the care of a paediatric bronchiectasis consultant or an adult consultant. I am wondering because my physio informed me that generally they do not advise postural draining with percussion now to paediatric cf or BE patients, as they have found paediatrics with reflux. I appreciate with the pandemic these are difficult times and I am not sure how much teaching and demonstrations of techniques physios are doing at present. I would have thought it of the greatest importance that your daughter is referred to a respiratory physio with experience with cf/bronchiectasis/PCD patients to learn lung clearance techniques and gadgets.

In the meantime I will put up a link of Patient Priorities - Bronchiectasis, which I was involved with for 18 months. It covers ‘normal’ lung function, bronchiectasis, self management and there are videos of Active Cycle of Breathing, Autogenic, the Flutter and the Acapella Choice. Please note some hospitals supply the Flutter and Acapella. You can certainly get the Flutter on prescription but your GP may not know this! If you purchase them, please make sure you get the medical VAT exemption form.

europeanlunginfo.org/bronch...

Depending on your daughter’s age you or her will need to learn to be your own advocates when it comes to BE. A lot for someone so young I know. BTW you will be needed for input as teenagers (and I was one of them once) are notorious whatever their condition to neglect management when there are so many other exciting teenage things to do. So you are still very much needed in the back seat.

Good luck and please let us know how you get on.

Love cx

[corriena in reply to cofdrop-UK]

Acapella device is also avalable on prescription if you ask

[cofdrop-UK in reply to corriena]

Yes I get mine on prescription. I should have included that. Thank you corriena. Useful for quebec to know that.

Cx

[Hidden]

A fabulous reply from cof drop. I really encourage you and your daughter to take her advice.

[Hidden]

I’m in a very similar situation in so far as child with cf is no longer shielding, but I’m still considered extremely clinically vulnerable due to being immunosuppressed for autoimmune driven issues. In spite of being old enough and extremely bright, my daughter isn’t capable of facilitating her own treatment as a result of also being on the autistic spectrum. Whilst we don’t do percussion these days, and without wanting to seem very negative, I still don’t think there is any way to feasibly protect yourself from another individual in the house unless you continue to very strictly follow the shielding guidance for living with others whereby you would eat separately, not spend time together etc. My daughter has the odd cough and splutter throughout the day and routinely needs to clear sputum as she’s generally very productive: there is no way to mitigate for that, so unless your child isn’t productive, or doesn’t cough at all outside of physio, not being involved with physio will reduce the risk somewhat, but there will still be an increased transmission risk compared to a child that doesn’t have a respiratory issue. As it’s just the two of us, I’m not in a position to fully follow the shielding guidance, so we’re taking the things like showering/changing clothes as soon as she comes home from school and doing those. It’s not ideal, but there isn’t much other choice.

As for alternative techniques, there are quite a few as others have said, most of which involve an airway clearance device. My daughter has been using the Aerobika for the last 3 years which is a combination of splinting the airway and vibrations, and so far that’s been the best device out of the ones we’ve tried, but we know she really benefits from pressure to splint her airways open due to an underlying problem she has. We usually do 4 cycles of 15 breaths with huffs in between, two in upright, one lying on each side. Acapellas are quite popular, those use vibrate but don’t splint, and again usually involve cycles with huffs in between. Both of these would be available via your hospital team, but you would need a physio to show you (collectively) correct technique. There is also straight PEP, which splints the airway without any oscillation. The benefit with a device would be that your teen may still need someone to supervise and make sure they are actually doing a proper job, but there‘s no hands on element - we’ve had staff at school be able to supervise using the aerobika with just a quick, 2 minute demonstration of the correct technique. The ‘easiest’ technique to do independently would be autogenic drainage (AD) and/or active breathing, as these don’t require any equipment, and as such can be done any time, anywhere, but they also require practice to get the most benefit out of them and effort. As Cof mentioned, all teens are notorious for compliance issues at some point in their journey, and breathing exercises for clearance are very much a case of you only get out what you put in.

[quebec in reply to Hidden]

Thank you all for your ideas - she is using active breathing technique before bed most days now which is going reasonably well. We tried the flutter without much success but the aerobika sounds useful and we will ask her consultant about it. We’re prepping for school now, and it feels like she’s heading for the Normandy beaches on d-day rather than school with her friends. The school don’t have space for social distancing, so it’s full classes of 30 in cramped rooms with hand gel and windows open, no masks. It doesn’t give a warm cosy feeling.