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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):
(Required.)
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
(Required.)
Female
Male
Other (please specify)
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3.
My age is:
(Required.)
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)
(Required.)
White or Caucasian
Black or African American
Hispanic or Latino
Asian or Asian American
American Indian or Alaska Native
Multiple ethnicities (please specify)
5.
In which country do you currently reside?
United States
Other (please specify)
6.
Did your doctor recommend that you start doing airway clearance therapy (ACT)?
Yes
No
7.
Are you currently doing ACT?
Yes
No
8.
How often is your ACT discussed during your CF visits?
Every visit
Most visits
Sometimes
Rarely
Never
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)
10.
Which of the following are part of your routine?
Bronchodilators (Levalbuterol®, Albuterol®, Salbutamol®)
(Hypertonic) Saline Concentration
Inhaled antibiotics
Exercise
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
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
Not at All True
A Bit True
Occasionally True
Somewhat True
Completely True
N/A
I am not able to explain the benefits of airway clearance
Not at All True
A Bit True
Occasionally True
Somewhat True
Completely True
N/A
I believe airway clearance is an important part of my care routine and makes me healthier.
Not at All True
A Bit True
Occasionally True
Somewhat True
Completely True
N/A
I am not aware of all the airway clearance options that are available to me.
Not at All True
A Bit True
Occasionally True
Somewhat True
Completely True
N/A
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
A Bit True
Occasionally True
Somewhat True
Completely True
N/A
My airway clearance skills need improvement.
Not at All True
A Bit True
Occasionally True
Somewhat True
Completely True
N/A
I consistently do my airway clearance routine each day.
Not at All True
A Bit True
Occasionally True
Somewhat True
Completely True
N/A
I am unhappy/dissatisfied with my current airway clearance routine.
Not at All True
A Bit True
Occasionally True
Somewhat True
Completely True
N/A
I continue doing my airway clearance routine when I am traveling.
Not at All True
A Bit True
Occasionally True
Somewhat True
Completely True
N/A
I am not comfortable doing airway clearance in front of friends.
Not at All True
A Bit True
Occasionally True
Somewhat True
Completely True
N/A
I am able to set aside time each day to perform airway clearance.
Not at All True
A Bit True
Occasionally True
Somewhat True
Completely True
N/A
I am able to find the time each day to perform airway clearance.
Not at All True
A Bit True
Occasionally True
Somewhat True
Completely True
N/A
My airway clearance routine gets in the way of doing things I want to accomplish each day.
Not at All True
A Bit True
Occasionally True
Somewhat True
Completely True
N/A
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)
14.
Use this space to add any thoughts about airway clearance not addressed in the sections above.
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.
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