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Routine airway clearance in asymptomatic infants and babies with cystic fibrosis in the UK: obligatory or obsolete?

Abstract Advances in medical management of children with cystic fibrosis has resulted in a cohort of apparently healthy infants who, nevertheless, have a life-long multisystem disorder. Physiotherapy approaches need to keep pace by adapting and developing techniques which are appropriate for families caring for seemingly asymptomatic babies. However, in the era of evidence-based medicine, adopting new approaches without a substantial evidence base risks the loss of potentially beneficial elements of traditional treatments. Early diagnosis (particularly neonatal screening), early aggressive prophylactic antibiotic therapy, and attention to nutrition have contributed to a significant change in the clinical status of many newborn infants and babies with cystic fibrosis. Most babies and young children attending cystic fibrosis centres now have good nutritional status, with a body mass index within normal limits. Physiotherapists caring for babies with cystic fibrosis face the dilemma of instigating routine therapy on diagnosis or waiting until the baby shows signs of respiratory symptoms. This issue has caused much disagreement amongst specialist physiotherapists internationally. This debate explores the arguments for and against new ideas in the physiotherapy management of asymptomatic infants and young children with cystic fibrosis.