Editing Cystic fibrosis (section)

===Procedures===
Several mechanical techniques are used to dislodge sputum and encourage its expectoration. One technique good for short-term airway clearance is [[Pulmonary hygiene#Conventional Chest physiotherapy|chest physiotherapy]] where a respiratory therapist percusses an individual's chest by hand several times a day, to loosen up secretions. This "percussive effect" can be administered also through specific devices that use [[chest wall oscillation]] or [[intrapulmonary percussive ventilator]]. Other methods such as [[biphasic cuirass ventilation]], and associated clearance mode available in such devices, integrate a cough assistance phase, as well as a vibration phase for dislodging secretions. These are portable and adapted for home use.<ref name="pmid37042825"/>

Another technique is positive expiratory pressure physiotherapy which consists of providing back pressure to the airways during expiration. This effect is provided by devices that consist of a mask or a mouthpiece in which resistance is applied only during the expiration phase.<ref name="pmid31774149">{{cite journal | vauthors = McIlwaine M, Button B, Nevitt SJ | title = Positive expiratory pressure physiotherapy for airway clearance in people with cystic fibrosis | journal = The Cochrane Database of Systematic Reviews | volume = 2019 | issue = 11 | date = November 2019 | pmid = 31774149 | pmc = 6953327 | doi = 10.1002/14651858.CD003147.pub5 }}</ref> Operating principles of this technique seem to be the increase of gas pressure behind mucus through [[collateral ventilation]] along with a temporary increase in functional residual capacity preventing the early collapse of small airways during exhalation.<ref name="pmid392747">{{cite journal | vauthors = Andersen JB, Qvist J, Kann T | title = Recruiting collapsed lung through collateral channels with positive end-expiratory pressure | journal = Scandinavian Journal of Respiratory Diseases | volume = 60 | issue = 5 | pages = 260–266 | date = October 1979 | pmid = 392747 }}</ref><ref name="pmid3899222">{{cite journal | vauthors = Groth S, Stafanger G, Dirksen H, Andersen JB, Falk M, Kelstrup M | title = Positive expiratory pressure (PEP-mask) physiotherapy improves ventilation and reduces volume of trapped gas in cystic fibrosis | journal = Bulletin Européen de Physiopathologie Respiratoire | volume = 21 | issue = 4 | pages = 339–343 | date = July 1985 | pmid = 3899222 }}</ref>

As lung disease worsens, mechanical breathing support may become necessary. Individuals with CF may need to wear special masks at night to help push air into their lungs. These machines, known as [[bilevel positive airway pressure]] (BiPAP) ventilators, help prevent low blood oxygen levels during sleep. Non-invasive ventilators may be used during physical therapy to improve sputum clearance.<ref name="Moran2017">{{cite journal | vauthors = Moran F, Bradley JM, Piper AJ | title = Non-invasive ventilation for cystic fibrosis | journal = The Cochrane Database of Systematic Reviews | volume = 2017 | issue = 2 | pages = CD002769 | date = February 2017 | pmid = 28218802 | pmc = 6464053 | doi = 10.1002/14651858.CD002769.pub5 }}</ref> It is not known if this type of therapy has an impact on pulmonary exacerbations or disease progression.<ref name="Moran2017" /> It is unknown what role non-invasive ventilation therapy has in improving exercise capacity in people with cystic fibrosis.<ref name="Moran2017" /> However, the authors noted that "non-invasive ventilation may be a useful adjunct to other airway clearance techniques, particularly in people with cystic fibrosis who have difficulty expectorating sputum".<ref name="pmid28218802">{{cite journal | vauthors = Moran F, Bradley JM, Piper AJ | title = Non-invasive ventilation for cystic fibrosis | journal = The Cochrane Database of Systematic Reviews | volume = 2017 | issue = 2 | pages = CD002769 | date = February 2017 | pmid = 28218802 | pmc = 6464053 | doi = 10.1002/14651858.CD002769.pub5 }}</ref> During severe illness, a tube may be placed in the throat (a procedure known as a [[tracheostomy]]) to enable breathing supported by a ventilator.<ref name="NHS-2018">{{cite web | title = Tracheostomy Why it's used | date = 3 October 2018 | publisher = NHS | url = https://www.nhs.uk/conditions/tracheostomy/why-its-done/ | access-date = 10 May 2020}}</ref><ref name="Molnar-2023">{{cite web| vauthors = Molnar H |title=Types of Tracheostomy Tubes |date=11 April 2023 |url= http://www.hopkinsmedicine.org/tracheostomy/about/types.html |language=en }}</ref>

For children, preliminary studies show [[massage therapy]] may help people and their families' quality of life.<ref name="pmid16229132">{{cite journal | vauthors = Huth MM, Zink KA, Van Horn NR | title = The effects of massage therapy in improving outcomes for youth with cystic fibrosis: an evidence review | journal = Pediatric Nursing | volume = 31 | issue = 4 | pages = 328–332 | year = 2005 | pmid = 16229132 }}</ref>

Some lung infections require surgical removal of the infected part of the lung. If this is necessary many times, lung function is severely reduced.<ref name="Leinwand-2019">{{cite web | vauthors = Leinwand MJ | veditors = Windle ML, Odim J | date = 28 December 2019 | work = Medscape | title = Surgical Treatment of Infections of the Lung, Pleura, and Mediastinum | url = http://emedicine.medscape.com/article/906209-overview#a2 | archive-url = https://web.archive.org/web/20161005230647/http://emedicine.medscape.com/article/906209-overview | archive-date=5 October 2016 }}</ref> The most effective treatment options for people with CF who have spontaneous or recurrent [[Pneumothorax|pneumothoraces]] is not clear.<ref name="Amin2012">{{cite journal | vauthors = Amin R, Noone PG, Ratjen F | title = Chemical pleurodesis versus surgical intervention for persistent and recurrent pneumothoraces in cystic fibrosis | journal = The Cochrane Database of Systematic Reviews | volume = 12 | issue = 12 | pages = CD007481 | date = December 2012 | pmid = 23235645 | pmc = 7208277 | doi = 10.1002/14651858.CD007481.pub3 }}</ref>