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Chest Physical Therapy

by Bartolome R. Celli, MD

Respiratory therapists use several different techniques to help treat lung disease, including postural drainage, suctioning, and breathing exercises. The choice of therapy is based on the underlying disease and the person's overall condition.

Postural drainage

In postural drainage, the person is tilted or propped at an angle selected to help drain secretions from the lungs. The chest or back may also be clapped with a cupped hand to help loosen secretions—a technique called chest percussion. Alternatively, the therapist may use a mechanical chest vibrator or teach a family member to use one.

These techniques are used at intervals on people who have conditions, such as cystic fibrosis, bronchiectasis, or lung abscess, that cause a great deal of sputum to be produced. The techniques may also be used when a person cannot cough up sputum effectively, as may happen with older people or with people who have muscle weakness or who are recovering from surgery, injury, or severe illness.

Postural drainage cannot be used for people who are unable to tolerate the position required, those taking anticoagulation drugs, those who have recently vomited up blood, those who have had a recent rib or vertebral fracture, or those who have severe osteoporosis. Postural drainage also should not be used for people who are unable to produce any secretions.


Respiratory therapists, nurses, and family members who have been taught the procedure may use suctioning to help remove secretions from the airways. A small plastic tube is introduced through the nose and extended a few inches into the windpipe (trachea). A gentle vacuum sucks out the secretions that cannot be coughed up. Suctioning is also used to remove secretions in someone who has a tracheostomy (a surgical opening in the trachea to allow breathing) or who has a breathing tube inserted through the nose or mouth and into the trachea (endotracheal tube) while on a ventilator.

Breathing exercises

Breathing exercises may help strengthen the muscles that inflate and deflate the lungs, but they do not directly improve lung function. Still, breathing exercises decrease the likelihood of lung complications after surgery in heavy smokers and other people with lung disease. Such exercises are particularly helpful for sedentary people who have chronic obstructive pulmonary disease or those who have just been taken off of a ventilator.

Often, these exercises involve using an instrument called an incentive spirometer. A person breathes in as deeply as possible through a tube that is attached to a hand-held plastic chamber. The chamber houses a ball, and each breath lifts the ball. Ideally, this maneuver is done 5 to 10 consecutive times each hour while the person is awake. This device is used routinely in hospitals before and after surgery. However, deep breathing exercises encouraged by nurses and respiratory therapists may be more effective than self-directed breathing exercises using an incentive spirometer.

Pursed-lip breathing is a type of breathing pattern that may be helpful when people who have chronic obstructive pulmonary disease overinflate their lungs during attacks of airway narrowing, panic, or exercise. It also can function as an additional breathing exercise for people undergoing pulmonary rehabilitation. People are taught—or often discover by themselves—to exhale against partially closed (pursed) lips, as if preparing to whistle. This measure increases pressure in the airways and helps prevent them from collapsing. The exercise causes no ill effects, and some people adopt the habit without instruction. People may also benefit from bending forward while doing pursed-lip breathing. In this position, the person stands with the arms and hands outstretched and supports the body on a table or similar structure. This position improves functioning of the diaphragm (the most important breathing muscle) and reduces shortness of breath.

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