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Airway Clearance Assessment CF Child
MY RESPIRATORY TREATMENTS
What breathing treatments do you every day? Find the treatments you do every day and answer the questions. You can draw an ”X“ through any medications or therapies that you do not do. If you aren’t sure, ask your parents or care team. You can also find out more about each treatment on the back of this worksheet.
Name
First
Last
Physician
(Required)
Name of Clinic
(Required)
Phone
Email
(Required)
RESPIRATORY TREATMENTS
Please select the devices/methods you use from the drop downs and indicate how frequently you use them.
RESPIRATORY TREATMENTS
Bronchodilators
Hypertonic Saline
Mucus Thinners (Mucolytics)
Treatment name
Bronchodilators treatment name
Hypertonic Saline treatment name
Mucus Thinners (Mucolytics) treatment name
How many times a day
Bronchodilators – How many times a day
Hypertonic Saline – How many times a day
Mucus Thinners (Mucolytics) – How many times a day
Dose
Bronchodilators
Hypertonic Saline
Mucus Thinners (Mucolytics)
How I feel about it
Bronchodilators
Hypertonic Saline
Mucus Thinners
RESPIRATORY TREATMENTS
Inhaled Antibiotics
Inhaled Corticosteroids
Treatment name
Inhaled Antibiotics treatment name
Inhaled Corticosteroids treatment name
Dose
Inhaled Antibiotics – Dose
Inhaled Corticosteroids – Dose
How many times a day
Inhaled Antibiotics – How many times a day
Inhaled Corticosteroids – How many times a day
How I feel about it
Inhaled Antibiotics – How I feel about it
Inhaled Corticosteroids – How I feel about it
AIRWAY CLEARANCE THERAPIES
Please select the devices/methods you use from the drop downs and indicate how frequently you use them.
AIRWAY CLEARANCE THERAPIES
Positive Expiratory Pressure (PEP)
Oscillating Positive Expiratory Pressure (OPEP)
Percussion (Hand Therapy) & Huff Coughing
Treatment name
Positive Expiratory Pressure (PEP) treatment name
Oscillating Positive Expiratory Pressure (OPEP) treatment name
Percussion (Hand Therapy) & Huff Coughing treatment name
How many times a day
Positive Expiratory Pressure (PEP) – How many times a day
Oscillating Positive Expiratory Pressure (OPEP) – How many times a day
Percussion (Hand Therapy) & Huff Coughing – How many times a day
How long each time
Positive Expiratory Pressure (PEP) – How long each time
Oscillating Positive Expiratory Pressure (OPEP) – How long each time
Percussion (Hand Therapy) & Huff Coughing – How long each time
How I feel about it
Positive Expiratory Pressure (PEP) – How I feel about it
Oscillating Positive Expiratory Pressure (OPEP) – How I feel about it
Percussion (Hand Therapy) & Huff Coughing – How I feel about it
AIRWAY CLEARANCE THERAPIES
Vest Therapy
Exercise
Treatment name
Vest Therapy – Treatment name
Exercise – Treatment name
How many times a day
Vest Therapy – How many times a day
Exercise – How many times a day
How long each time
Vest Therapy – How long each time
Exercise – How long each time
How I feel about it
Vest Therapy – How I feel about it
Exercise – How I feel about it
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