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The Most Essential Airway Clearance Technique

Putting Your Cough to Good Use


Updated June 13, 2014

Airway clearance is an important part of daily life for people with cystic fibrosis. Not everyone uses the same airway clearance technique (ACT) or combination of techniques, but coughing is usually included in the routine. By itself, coughing is not a particularly effective method of airway clearance for those with CF -- but it is an essential step in removing the mucus that is loosened up by other ACTs. For this reason, coughing can arguably be considered the most important ACT that people with cystic fibrosis (CF) can use.

Effective Coughing

Coughing is a reflex that all people with healthy neuromuscular systems have. Coughs are triggered by the body when it needs to remove irritants and mucus from the airways. People with CF cough reflexively just as everyone does, but reflexive coughing is different than the type of cough that is done as an ACT.

Unlike reflexive coughing, which can sometimes be spasmodic and shallow, ACT coughing is purposeful, deep, and controlled. After other techniques have loosened the mucus, effective coughing will help bring it out. The goal is to get as much air behind the mucus as possible, so the force of the cough will propel it outward. To do this:

  1. Take a big deep breath, filling the lungs as completely as possible.
  2. Contract the upper abdominal muscles.
  3. Expel all of the air using one forceful cough.
  4. Repeat the process one or two times until the loosened mucus is removed from the airway.

Coughing vs Huffing

In some people with cystic fibrosis, the force of coughing can actually cause the airways to collapse. Instead of coughing, these people often use a Forced Expiratory Technique (FET) known as huffing instead of coughing. In those that can tolerate coughing, huffing can also be used as a first step to bring mucus to the upper airways, followed by a forceful cough to bring the mucus all the way out. Huffing is similar to coughing, but is not quite as forceful. To do this:

  1. Take a big deep breath, filling the lungs as completely as possibly.
  2. Blow the air out in forceful bursts through an open mouth while saying “huh,” as if you are blowing steam onto a mirror.
  3. Repeat as many times as needed to clear the loosened mucus from the airway.


McCool, F. D. MD, FCCP and Rosen, M.J. MD, FCCP. “Nonpharmacologic Airway Clearance Therapies: ACCP Evidence-Based Clinical Practice Guidelines”. Chest. 2006;129:250S-259S. 8 November 2008.

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