Chest Physiotherapy (CPT) is a non-invasive technique designed to help people with respiratory conditions clear excess or thickened mucus from their lungs. It uses external manipulation and positioning to loosen secretions that natural clearance mechanisms struggle to remove. By facilitating the movement of mucus from smaller airways into the larger central airways, CPT aims to make it easier to expel the material by coughing. The techniques focus on improving ventilation, reducing the risk of infection, and enhancing overall lung function in adults experiencing secretion build-up.
Indications and Pre-Procedure Setup
Chest physiotherapy is recommended for adult patients whose cough is insufficient to clear tenacious or copious secretions. Conditions like bronchiectasis, cystic fibrosis, and certain neuromuscular disorders that impair the mucociliary escalator often require CPT. It may also be indicated for individuals with pneumonia in dependent lung regions or in cases of Chronic Obstructive Pulmonary Disease (COPD) where mucus retention is a concern.
Preparation is necessary to ensure safety and effectiveness. The patient should avoid eating a large meal 30 to 45 minutes before the session to prevent discomfort or aspiration in specific drainage positions. The caregiver needs to gather materials: a container for sputum, tissues, and a towel to place over the skin.
The patient must be positioned to use gravity, targeting the specific lung segments that require drainage. Before starting, the patient’s vital signs, including heart rate and oxygen saturation, should be checked and monitored to ensure stability. Explaining the procedure to the patient and ensuring they are comfortable helps maximize cooperation and the success of the treatment.
Manual Techniques for Secretion Mobilization
CPT begins with manual techniques performed by a caregiver or therapist to dislodge mucus from the airway walls. Postural drainage is the first component, using specific body positions to align the lung segment being treated so gravity assists the flow of secretions toward the central airways. For example, to drain the lower lobes, the patient might be placed in a side-lying position with the head of the bed angled down in a modified Trendelenburg position.
Percussion, or clapping, is applied over the affected lung segment to shake the secretions loose. The hand must be cupped, creating an air cushion that produces a hollow sound when striking the chest wall, not a flat, slapping noise. This cupping technique prevents pain and injury while transmitting the mechanical force needed to mobilize the mucus.
Percussion is performed rhythmically for three to five minutes over the target area, avoiding sensitive regions like the spine, sternum, clavicles, or kidneys. Following percussion, vibration is applied by the caregiver placing a flat hand over the area and generating a fine, gentle, oscillating movement. This vibration is coordinated with the patient’s exhalation to transmit kinetic energy through the chest wall, further moving the loosened secretions.
Patient-Assisted Methods for Expulsion
Once secretions are mobilized, the patient must actively participate to move the mucus out of the body. The Active Cycle of Breathing Techniques (ACBT) is a structured sequence of voluntary actions that helps facilitate this expulsion. This cycle begins with “Breathing Control,” which involves resting and breathing gently at a normal rate to prevent breathlessness and maintain relaxation.
Next are “Thoracic Expansion Exercises,” where the patient takes three to five slow, deep breaths, holding the inhalation for two to three seconds before a relaxed exhalation. These deep breaths encourage air to move past the secretions, helping to shift them toward the larger airways by utilizing collateral ventilation. The final component is the “Huff,” or Forced Expiratory Technique.
A huff is a forced exhalation performed with an open glottis, similar to steaming up a mirror. This action generates a high-velocity airflow in the upper airways, which shears the mucus off the bronchial walls without causing the airway collapse that a hard cough might induce. The patient is encouraged to huff one or two times after a set of deep breaths, followed by a return to breathing control, and then attempting an effective cough to clear the secretions.
Safety Guidelines and Contraindications
Safety is primary during CPT, and the procedure must be modified or avoided in certain clinical situations. Absolute contraindications include an unstable cardiovascular status, such as uncontrolled hypertension or cardiac arrhythmias, and recent hemoptysis (coughing up of blood). The vigorous nature of percussion is also avoided in cases of recent rib fractures, osteoporosis, or fragile chest walls due to the risk of further injury.
The procedure must be immediately stopped if the patient reports pain, severe shortness of breath, or dizziness, or if vital signs change significantly. CPT is also relatively contraindicated in patients with elevated intracranial pressure or a recent neurosurgical procedure, as certain positions can worsen these conditions. Caregivers must be aware of these risks and adjust the technique, position, or duration to ensure the patient’s well-being.