Airway Clearance Assessment CF Child MY RESPIRATORY TREATMENTSWhat breathing treatments do you every day? Find the treatments you do every day and answer the questions. Skip any medications or therapies that you do not do. If you aren’t sure, ask your parents or care team. First Name Last Name Physician* Name of Clinic* RESPIRATORY TREATMENTSPlease write the names of the treatments you do in the boxes below. Write how often you use them in the next two boxes. Then, pick the smiley face that best matches how you feel about doing that treatment Device/Method Treatment Name How many times a day How many puffs or minutes How I feel about it Bronchodilators Treatment nameHow many times a dayHow many puffs or minutesHow I feel about it Hypertonic Saline Treatment nameHow many times a dayHow many puffs or minutesHow I feel about it Mucus Thinners (Mucolytics) Treatment nameHow many times a dayHow many puffs or minutesHow I feel about it Inhaled Antibiotics Treatment nameHow many times a dayHow many puffs or minutesHow I feel about it Inhaled Corticosteroids Treatment nameHow many times a dayHow many puffs or minutesHow I feel about it AIRWAY CLEARANCE THERAPIESPlease write the names of the treatments you do in the boxes below. Write how often you use them in the next two boxes. Then, pick the smiley face that best matches how you feel about doing that treatment Device/Method Treatment name How many times a day How many puffs or minutes How I feel about it Positive Expiratory Pressure (PEP) Treatment nameHow many times a dayHow many puffs or minutesHow I feel about it Oscillating Positive Expiratory Pressure (OPEP) Treatment nameHow many times a dayHow many puffs or minutesHow I feel about it Percussion (Hand Therapy) & Huff Coughing Treatment nameHow many times a dayHow many puffs or minutesHow I feel about it Vest Therapy Treatment nameHow many times a dayHow many puffs or minutesHow I feel about it Exercise Treatment nameHow many times a dayHow many puffs or minutesHow I feel about it 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
