Endurance race

Question

Hello,
Can a small 40-minute endurance race for about 4.5 km replace a physiotherapy session in a 9 year-old child who has 6 sessions per week.
There is no breathlessness, no cough nor bronchial congestion during this effort.
A big thank you and to your team for your answers.

Answer

Hello,
Bronchial drainage is the basic treatment of cystic fibrosis. Regarding the "evidence-based medicine", it is difficult to say that a technique is better than another: it is actually impossible to apply to the assessment of bronchial drainage techniques the so called "double blind" method rigorously that is used to scientifically evaluate the effectiveness of a drug by comparing it to a placebo.
Specifically, we can consider that the best practices are those that may compel the patient to regularly perform them by taking into account the following five steps:
- hydration by adequate salt and water intake;
- dilatation of the bronchi, if they are hyper-reactive, with an inhaled bronchodilator;
- promote the inhaled air in the small airways, downstream secretions, by slow and deep breaths;
- blow up secretions with a sufficient expiration flow;
- swallow or spit the sputum (in accordance with the hygiene rules).
These steps must be applied whatever the activities are that may perform bronchial drainage:
- during a conventional chest physiotherapy;
- during physical activity (a small endurance race why not, but maybe not 40 minutes to start) whose regular practice should be encouraged as long as it is compatible with the abilities of the person (either sick or not) and it pleases him/her;
- during a playful or artistic activity like singing that can be particularly recommended for people with CF because it is a fun way to learn how to breathe properly;
- ...
These different drainage possibilities do not exclude each other. Instead, combination or switching avoids fatigue.
You can also contact your CF Centre to ask for therapeutic education sessions: their aim is to better understand the disease and to develop adaptational skills in the daily life.
It is also important to keep in regular contact with his/her physiotherapist, on the one hand because he/she is able to assist the patient in learning these techniques, on the other hand, because it is often the professional who best knows the patient and can detect early change of health.
Hope that answers your question.
Sincerely.
Dr Gilles RAULT

31.07.2013