Summary The lungs of people with cystic fibrosis (CF) are affected by a basic ion transport defect leading to more viscid airway mucus. This is an ideal breeding ground for bacteria with which the lungs can become chronically colonised from an early age, leading to progressive obstructive pulmonary disease. The principles of treatment include airway clearance by physiotherapy and prophylaxis and treatment of infection with antibiotics. An audit of the physiotherapy service and knowledge and use of nebulisers by adults attending the Regional Cystic Fibrosis Centre at Birmingham Heartlands Hospital is presented. A self-administered questionnaire revealed that despite regular review and tuition by experienced senior CF physiotherapists, adherence, knowledge and practices were unsatisfactory. The need for individually tailored airway clearance techniques and exercise programmes was highlighted. Clinical guidelines covering in particular nebulised/inhaled drug usage and timing in relation to physiotherapy were shown to be necessary to augment practical teaching. Improved access to out-patient physiotherapy services and regular review when well at home were requested by many CF adults. Practical changes to the service have been implemented and recommendations made with a view to further assessment in 12 months to complete the audit loop.