The Obstacles to Expectorating Sputum in Cystic Fibrosis (CF) Patients

Introduction: Expectoration of sputum is an important part of effective airway clearance. Aim: Our aim is to investigate what are the obstacles that CF patients are facing during expectoration of sputum. Method: 9 point questionnaire was created and distributed from January to December 2021 among CF patients, from the Institute for respiratory diseases in children in Skopje, Republic of North Macedonia. 35 patients who were eligible, completed the questionnaire. Their weight, height, BMI and FEV1 were also evaluated. Results: Median age of the patients was 22.54 years (7-44 years), 54.3% were male and 88.57% had at least one F508del mutation. The mean BMI was 20.29 kg/m2 (range: 13.0-30.8) and median FEV1 72.8% (range: 21-127). 51.42% of the patients always expectorated sputum and the same percent didn’t find it difficult to bring it up. More than half of the patients (51.42%) are not annoyed by the sputum. 16 of 35 sometimes experienced shortness of breath during expectoration. 60% reported that sputum never had influence on their ability to speak, but the same percent sometimes felt uncomfortable about bothering other people while bringing up sputum. Majority of the patients (85.71%) do not avoid going to public places because of expectorating sputum (movie theaters, restaurants). 19 reported that usual activities were never interrupted by sputum. Half of the patients experienced some degree of shame and worry while expectorating, other half sometimes had physical difficulties/nausea/vomiting. Conclusion: The main obstacle to expectorating sputum among CF patients are shortness of breath and uncomfortable feeling about bothering other people while bringing up sputum usually expressed as shame and worry.