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Chest Physiotherapy

By Jessica Bon Field, MD, Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh ; Andrea Levine, MD, Fellow, Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh Medical Center

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Chest physiotherapy consists of external mechanical maneuvers, such as chest percussion, postural drainage, and vibration, to augment mobilization and clearance of airway secretions. It is indicated for patients in whom cough is insufficient to clear thick, tenacious, copious, or loculated secretions. Examples include patients with

Despite relatively few high-quality clinical trials providing strong evidence-based support, chest physiotherapy remains an important component of care in patients with cystic fibrosis.

Contraindications

Contraindications to chest physiotherapy all are relative and include the following:

  • Discomfort due to physical positions or manipulations

  • Anticoagulation

  • Rib fractures

  • Vertebral fractures or osteoporosis

  • Recent hemoptysis

Procedure

Chest physiotherapy may be administered by a respiratory therapist, although the techniques can often be taught to family members of patients.

The most common procedure used is

  • Postural drainage and chest percussion

In postural drainage and chest percussion, the patient is rotated to facilitate drainage of secretions from a specific lung lobe or segment while being clapped with cupped hands to loosen and mobilize retained secretions that can then be expectorated or drained. The procedure is somewhat uncomfortable and tiring for the patient. Alternatives to chest percussion by hand include use of mechanical vibrators and inflatable vests.

Other methods that help clear airways include using controlled patterns of breathing, positive expiratory pressure devices to maintain airway patency, and ultra-low-frequency airway oscillation devices to mobilize sputum. The methods of airway clearance are comparable, and methods should be selected based on individual patient needs and preferences.

Complications

Complications are unusual but include position-related hypoxia and aspiration of freed secretions in other lung regions.