Action Plan CF AIRWAY CLEARANCE ACTION PLANA copy of this Action Plan should be provided at the conclusion of the clinic visit for reference at home. Clinicians should retain a copy in the patient’s chart for review during the next visit.First NameLast NamePhysician*Name of Clinic*Phone # (optional)Email* 1. Which treatment methods are you currently using?Please select the devices/methods you use from the drop downs and indicate how frequently you use them.Treatment NameNumber of puffs or minutesTimes a day?Days a week?BronchodilatorsSelectProventil®ProAir®Ventolin®Xopenex®Serevent®Spiriva®OtherHow many times a day?How long each time?How many times a week?Other Inhaled BronchodilatorsHypertonic SalineSelectHypersal®Pulmosal®Sodium Chloride3 %3.5 %7 %How many times a day?How long each time?How many times a week?Mucolytics (Mucus Thinners)SelectPulmozyme®Mucomyst®OtherHow many times a day?How long each time?How many times a week?Other Mucolytics/Mucus ThinnersAirway Clearance TechniquesTreatment NameNumber of puffs or minutesTimes a day?Days a week?Positive Expiratory Pressure (PEP)SelectResistex PEP MaskTheraPEP®How many times a day?How long each time?How many times a week?Oscillating Positive Expiratory Pressure (OPEP)SelectAcapella Choice®Aerobika®Flutter®Lung Flute®RC-Cornet®OtherHow many times a day?How long each time?How many times a week?Other OPEPHigh-Frequency Chest Wall Oscillation (Mobile)SelectAffloVest®Monarch®How many times a day?How long each time?How many times a week?High-Frequency Chest Wall Oscillation (Stationary)SelectThe Vest®InCourage®SmartVest®How many times a day?How long each time?How many times a week?Huff CoughingHow many times a day?How long each time?How many times a week?Percussion and Postural DrainageHow many times a day?How long each time?How many times a week?Active Cycle of Breathing Techniques (ACBT)How many times a day?How long each time?How many times a week?Autogenic DrainageHow many times a day?How long each time?How many times a week?Intrapulmonary Percussive Ventilation (IPV)How many times a day?How long each time?How many times a week?Other:How many times a day?How long each time?How many times a week?Exercise: Please specify which type:How many times a day?How long each time?How many times a week?Inhaled AntibioticsSelectCayston®TOBI®TOBI Podhaler®Bethkis®Colistin®How many times a day?How long each time?How many times a week?Inhaled CorticosteroidsSelectFlovent®Pulmicort®QVar®How many times a day?How long each time?How many times a week?2. Other Notes / Recommendations3. Educational ResourcesIt is recommended that you explore the following educational resources on: www.IMPACT-CF.com/patient-resourcesRespiratory treatments and therapies Bronchodilators Hypertonic Saline Mucolytics Exercise Inhaled Antibiotics Inhaled Corticosteroids Airway Clearance Therapies (ACTs) PEP OPEP Vest Mobile Vest Stationary Huff coughing Inhaled Corticosteroids Percussion & Postural Drainage Active cycle of breathing technique (ACBT) Autogenic Drainage (AD) Chest Physical Therapy (CPT) Intrapulmonary percussive ventilation (IPV) About Airway Clearance How Airway Clearance Improves Overall Well-being Review of Airway Clearance Therapy Prioritizing Airway Clearance Why is Airway Clearance Therapy so Important? Doing Airway Clearance While “On the Go” Fitting Airway Clearance Into a Busy Day Doing Airway Clearance While On Vacation Skills Order of therapies Order of medications Using a nebulizer Nebulizer care at home Cleaning your spacer Cleaning your nebulizer Cleaning your PEP Support Support systems Talking about CF Managing Anxiety Partnering with your care team Adhering to Treatment CF and school Relationships and CF Cleaning Equipment Responsibility for care Recognizing Flare ups (exacerbations) Life with CF Order of therapies Download your PDF Now review the form below to verify that it is complete and accurate, if necessary scroll back up to correct information. The preview should automatically load your information, if it does not click the reload icon below to reload it. Once you have verified all your information, click the Download PDF button to save the form to your computer. To protect your privacy we do not save your information, so be sure to move your file to a secure, accessible location after downloading. Your PDF
