Airway Clearance Assessment for CF

Please take a few minutes to complete the following survey on airway clearance. The results of this survey will help inform clinicians who are treating patients like you and will help inform industry and regulators as new therapies are developed.

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* 1. I have been diagnosed with these lung conditions (please check all that apply):

Bronchiectasis

A nontuberculous mycobacterial lung infection

Cystic Fibrosis

Primary Ciliary Dyskinesia

Chronic Obstructive Pulmonary Disease (COPD)

Alpha-1 Antitrypsin Deficiency

Other (please specify)

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* 2. My gender is

Female

Male

Other (please specify)

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* 3. My age is:

Under 18

18-24

25-34

35-44

45-54

55-64

65+

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* 4. Which race/ethnicity best describes you? (Please choose only one)

White or Caucasian

Black or African American

Hispanic or Latino

Asian or Asian American

American Indian or Alaska Native

Multiple ethnicities (please specify)

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* 5. In which country do you currently reside?

United States

Other (please specify)

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* 6. Did your doctor recommend that you start doing airway clearance therapy (ACT)?

Yes

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* 7. Are you currently doing ACT?

Yes

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* 8. How often is your ACT discussed during your CF visits?

Every visit

Most visits

Sometimes

Rarely

Never

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* 9. Which airway clearance method(s) are you currently using? (Please select all that apply)

Huff coughing

Positive Expiratory Pressure (PEP) (Pep Valve®, PEP Mask®)

Oscillating Positive Expiratory Pressure (OPEP) (Flutter®, Acapella®, Aerobika®, Lung Flute®)

High Frequency Chest Wall Oscillation (AffloVest®, The Vest®, InCourage®, Monarch®)

Active Cycle of Breathing Techniques/Autogenic Drainage

Chest Physical Therapy (CPT)/Postural Drainage

None

Other (please specify)

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* 10. Which of the following are part of your routine?

Bronchodilators (Levalbuterol®, Albuterol®, Salbutamol®)

(Hypertonic) Saline Concentration

Inhaled antibiotics

Exercise

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* 11. How many times per day do you do your airway clearance?

Once a day

Twice a day

3-4 times a day

Once a week

2-4 times a week

5-6 times a week

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* 12. To what extent do you agree or disagree with each of the following statements? Check the box that applies to each statement.

	Not at All True	A Bit True	Occasionally True	Somewhat True	Completely True	N/A
I understand what airway clearance is	I understand what airway clearance is Not at All True	I understand what airway clearance is A Bit True	I understand what airway clearance is Occasionally True	I understand what airway clearance is Somewhat True	I understand what airway clearance is Completely True	I understand what airway clearance is N/A
I am not able to explain the benefits of airway clearance	I am not able to explain the benefits of airway clearance Not at All True	I am not able to explain the benefits of airway clearance A Bit True	I am not able to explain the benefits of airway clearance Occasionally True	I am not able to explain the benefits of airway clearance Somewhat True	I am not able to explain the benefits of airway clearance Completely True	I am not able to explain the benefits of airway clearance N/A
I believe airway clearance is an important part of my care routine and makes me healthier.	I believe airway clearance is an important part of my care routine and makes me healthier. Not at All True	I believe airway clearance is an important part of my care routine and makes me healthier. A Bit True	I believe airway clearance is an important part of my care routine and makes me healthier. Occasionally True	I believe airway clearance is an important part of my care routine and makes me healthier. Somewhat True	I believe airway clearance is an important part of my care routine and makes me healthier. Completely True	I believe airway clearance is an important part of my care routine and makes me healthier. N/A
I am not aware of all the airway clearance options that are available to me.	I am not aware of all the airway clearance options that are available to me. Not at All True	I am not aware of all the airway clearance options that are available to me. A Bit True	I am not aware of all the airway clearance options that are available to me. Occasionally True	I am not aware of all the airway clearance options that are available to me. Somewhat True	I am not aware of all the airway clearance options that are available to me. Completely True	I am not aware of all the airway clearance options that are available to me. N/A
I am willing to work closely with my care team to find the airway clearance routine that is best for me.	I am willing to work closely with my care team to find the airway clearance routine that is best for me. Not at All True	I am willing to work closely with my care team to find the airway clearance routine that is best for me. A Bit True	I am willing to work closely with my care team to find the airway clearance routine that is best for me. Occasionally True	I am willing to work closely with my care team to find the airway clearance routine that is best for me. Somewhat True	I am willing to work closely with my care team to find the airway clearance routine that is best for me. Completely True	I am willing to work closely with my care team to find the airway clearance routine that is best for me. N/A
My airway clearance skills need improvement.	My airway clearance skills need improvement. Not at All True	My airway clearance skills need improvement. A Bit True	My airway clearance skills need improvement. Occasionally True	My airway clearance skills need improvement. Somewhat True	My airway clearance skills need improvement. Completely True	My airway clearance skills need improvement. N/A
I consistently do my airway clearance routine each day.	I consistently do my airway clearance routine each day. Not at All True	I consistently do my airway clearance routine each day. A Bit True	I consistently do my airway clearance routine each day. Occasionally True	I consistently do my airway clearance routine each day. Somewhat True	I consistently do my airway clearance routine each day. Completely True	I consistently do my airway clearance routine each day. N/A
I am unhappy/dissatisfied with my current airway clearance routine.	I am unhappy/dissatisfied with my current airway clearance routine. Not at All True	I am unhappy/dissatisfied with my current airway clearance routine. A Bit True	I am unhappy/dissatisfied with my current airway clearance routine. Occasionally True	I am unhappy/dissatisfied with my current airway clearance routine. Somewhat True	I am unhappy/dissatisfied with my current airway clearance routine. Completely True	I am unhappy/dissatisfied with my current airway clearance routine. N/A
I continue doing my airway clearance routine when I am traveling.	I continue doing my airway clearance routine when I am traveling. Not at All True	I continue doing my airway clearance routine when I am traveling. A Bit True	I continue doing my airway clearance routine when I am traveling. Occasionally True	I continue doing my airway clearance routine when I am traveling. Somewhat True	I continue doing my airway clearance routine when I am traveling. Completely True	I continue doing my airway clearance routine when I am traveling. N/A
I am not comfortable doing airway clearance in front of friends.	I am not comfortable doing airway clearance in front of friends. Not at All True	I am not comfortable doing airway clearance in front of friends. A Bit True	I am not comfortable doing airway clearance in front of friends. Occasionally True	I am not comfortable doing airway clearance in front of friends. Somewhat True	I am not comfortable doing airway clearance in front of friends. Completely True	I am not comfortable doing airway clearance in front of friends. N/A
I am able to set aside time each day to perform airway clearance.	I am able to set aside time each day to perform airway clearance. Not at All True	I am able to set aside time each day to perform airway clearance. A Bit True	I am able to set aside time each day to perform airway clearance. Occasionally True	I am able to set aside time each day to perform airway clearance. Somewhat True	I am able to set aside time each day to perform airway clearance. Completely True	I am able to set aside time each day to perform airway clearance. N/A
I am able to find the time each day to perform airway clearance.	I am able to find the time each day to perform airway clearance. Not at All True	I am able to find the time each day to perform airway clearance. A Bit True	I am able to find the time each day to perform airway clearance. Occasionally True	I am able to find the time each day to perform airway clearance. Somewhat True	I am able to find the time each day to perform airway clearance. Completely True	I am able to find the time each day to perform airway clearance. N/A
My airway clearance routine gets in the way of doing things I want to accomplish each day.	My airway clearance routine gets in the way of doing things I want to accomplish each day. Not at All True	My airway clearance routine gets in the way of doing things I want to accomplish each day. A Bit True	My airway clearance routine gets in the way of doing things I want to accomplish each day. Occasionally True	My airway clearance routine gets in the way of doing things I want to accomplish each day. Somewhat True	My airway clearance routine gets in the way of doing things I want to accomplish each day. Completely True	My airway clearance routine gets in the way of doing things I want to accomplish each day. N/A

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* 13. Which of the following might get in the way of doing your current airway clearance routine or adding a new airway clearance option? (Check all items that apply)

High out-of-pocket cost

It's difficult to set up

It's too complicated

It takes too much time

It disrupts my daily life

I can't travel with it

Prefer to exercise

I don't think it helps me

I don't need it

I'm not sure why I should do it

I forget to do it

It's uncomfortable/hurts

It makes my cough worse

Gets in the way of social time

It may cause bleeding

It reminds me of my disease

It's embarassing

I don't want others to know

None of these

Other (please specify)

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* 14. Use this space to add any thoughts about airway clearance not addressed in the sections above.

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* 15. Would you be interested in participating in a public health panel to help provide educational material for the CF community in the future? If so, please enter your email address below.

Thank you for taking the time to complete this survey. We appreciate the time you have taken to help us better understand your needs and preferences with airway clearance.

Please proceed to the next screen to submit your survey responses.