implementation:"The most important thing was that both Katrin and the parents agreed that the children were able to inhale at an early age and that there were generally no physical problems with inhalation in general. This reinforced our decision to work towards delivery by inhalation. It was very interesting to see the different ways children deal with their exercises and hear about the progress they made. ",
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<strong>Robin (>10)</strong>
<strong>Robin (>10)</strong>
<p>Robin will soon start 4th grade and takes modulators. Since taking them, many problems have subsided. No regular pneumonia with long hospital stays and the mucus comes out easier. Nevertheless, Robin still goes to physiotherapy regularly to do manual breathing therapy to get the mucus out. Katrin tells us how the mucus changes color the longer it stays in the lungs. The new mucus is white, and the older mucus gets yellow first and then gets darker with time until it reaches a black color. Nowadays, Robin rarely has dark mucus or clumps, but we can still hear the rustling as Katrin starts the autogenous drainage (Autogene Drainage) by pressing on Robin's chest. The goal is to get out the mucus deep in the lungs. To do that, Robin must repeat the routine – breathing in deeply, holding, breathing out – multiple times and then cough and spit the mucus out. Sometimes it works, but other times the mucus does not come out easily. While according to Katrin the autogenous drainage is the gold standard, they do other useful exercises, too. For example, pressing the Vojta points (which the children call “the magic points”) on the chest to activate a deep breathing reflex and get air into parts of the lungs that may not have been used previously. Or physical activity such as climbing a few steps on a climbing ladder and hanging on it to stretch the thorax muscles.</p>
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<strong>Sam (<10)&Alex(<10)</strong>
<strong>Sam (<10) & Alex (<10)</strong>
<p>Sam and Alex are siblings and do not have CF but another affliction that causes a persistent cough. They come together with a parent twice a week and do hanging exercises from the ceiling, nasal showers with needleless syringes, and the “magic points.” Katrin also checks their lungs for mucus in a similar manner to autogenous drainage. We, too, tried to do the nasal shower, and being a grown-up really does not guarantee being able to do that properly! This highlighted that the children know all their exercises by heart at a young age. On request, their parent told us that the physiotherapy made a big difference for both of them.</p>
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<strong>Toni (<5)</strong>
<strong>Toni (<5)</strong>
<p>Toni has a light version of CF and has been doing physiotherapy with Katrin since shortly after birth. In contrast to most children we met or talked about, Toni refuses medication. Modulators are a possibility, but them and 'everything stinky' is a no-go, even though inhaling would be very beneficial due to the mucus buildup. Most exercises result in crying and screaming, which is very exhausting for the child. Due to the light nature of Toni's variant, they are not in danger, but a permanent therapy would be very beneficial.</p>
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<strong>Chrissi (>10)</strong>
<strong>Chrissi (>10)</strong>
<p>Chrissi takes modulators and will soon take a trip to a water park with some friends. Katrin teaches us that when the children do not breathe out properly, air stays in the lungs and causes hyperinflation – with which it is actually harder to float in water! After the manual drainage, Katrin gets all of us glasses with water and dish soap and straws. Blowing bubbles is a playful way to train how to properly breathe out by either trying to blow bubbles as long as possible or trying to make an existing bubble as big as possible!</p>
