Comparative Effects of Autogenic Drainage and Mechanical Percussion on Lung Function, Dyspnea and Quality of Life in Children With Cystic Fibrosis

Cystic fibrosis (CF) is a life-limiting autosomal recessive genetic disorder caused by mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene. Dysfunction of the CFTR protein leads to impaired chloride and water transport across epithelial surfaces, resulting in the production of thick, dehydrated secretions in multiple organ systems, particularly the respiratory tract. The accumulation of viscous mucus within the airways contributes to chronic airway obstruction, recurrent pulmonary infections, persistent inflammation, progressive lung damage, and declining respiratory function. Despite advances in pharmacological treatment and supportive care, pulmonary complications remain the leading cause of morbidity and mortality in individuals with cystic fibrosis.

Airway clearance therapy is a fundamental component of respiratory management in patients with CF. The primary objective of airway clearance techniques (ACTs) is to mobilize and remove retained airway secretions, thereby improving ventilation, reducing airway obstruction, minimizing infection risk, preserving lung function, and enhancing quality of life. Various ACTs are available and are routinely incorporated into multidisciplinary CF care programs. However, determining the most effective airway clearance strategy remains challenging because patient responses vary and comparative evidence among techniques is often limited.

Autogenic drainage (AD) is an airway clearance technique based on controlled breathing at different lung volumes. The technique consists of three phases: unsticking, collecting, and evacuating secretions. Through carefully regulated inspiratory and expiratory airflow, AD promotes mucus mobilization from peripheral airways toward central airways where it can be effectively expectorated. Because the technique relies on self-regulated breathing rather than external mechanical forces, it may improve patient comfort, encourage independence, and facilitate long-term adherence. Previous studies have suggested that AD may improve pulmonary function, reduce airway resistance, enhance mucus clearance, and improve patient satisfaction. Nevertheless, evidence in pediatric populations remains limited.

Mechanical percussion is another commonly utilized airway clearance intervention in cystic fibrosis management. This technique employs rhythmic mechanical vibrations or percussion applied externally to the thoracic cage to loosen mucus adhered to airway walls. Mechanical percussion aims to facilitate mucus mobilization and subsequent clearance from the respiratory tract. The technique is frequently used in pediatric respiratory rehabilitation because it requires minimal active participation from younger children and can be administered by healthcare professionals or caregivers. Several studies have reported beneficial effects of mechanical percussion on secretion clearance and respiratory status. However, concerns regarding comfort, treatment burden, and long-term adherence have led clinicians to explore alternative airway clearance approaches.

Although both autogenic drainage and mechanical percussion are widely used in clinical practice, direct comparisons between these interventions in children with cystic fibrosis are scarce. Existing studies often include mixed age groups, employ heterogeneous outcome measures, or focus primarily on short-term physiological responses. Furthermore, limited evidence is available regarding their comparative effects on patient-centered outcomes such as dyspnea and health-related quality of life. Consequently, there remains uncertainty regarding which intervention provides superior clinical benefits for pediatric patients with CF.