Chest Physiotherapy (CPT) is an airway clearance technique that uses manual manipulation of the chest wall and specific positioning to help adults clear excess mucus from the lungs. This process moves secretions from smaller airways to the central passages. The goal of CPT is to loosen and expel accumulated mucus, which improves ventilation, enhances gas exchange, and reduces the risk of respiratory infection. By facilitating the removal of secretions the patient cannot clear independently, CPT helps make breathing easier for those with certain lung conditions.
Identifying When CPT Is Necessary
CPT is generally indicated for adult patients whose natural cough mechanism is insufficient to clear secretions from the lungs. Common medical conditions that benefit from this intervention include cystic fibrosis, bronchiectasis, severe pneumonia, and chronic obstructive pulmonary disease (COPD). It is also frequently used in post-operative care, particularly following chest or abdominal surgery, where pain or immobility hinders effective coughing and leads to secretion buildup. A healthcare provider, such as a doctor or physical therapist, must prescribe or recommend CPT before it is initiated.
CPT should be avoided in specific situations due to the risk of serious complications. Absolute contraindications include an untreated tension pneumothorax, which is a medical emergency. Vigorous manual techniques must also be avoided in patients with unstable cardiovascular status, such as an erratic heartbeat, unstable blood pressure, or a recent myocardial infarction.
Caution is necessary if the patient has a bleeding diathesis (increased risk of hemorrhage) or recent hemoptysis (coughing up blood). CPT is also relatively contraindicated in cases of rib fractures, osteoporosis, or an unstable chest wall. Furthermore, avoid performing CPT over fresh surgical incisions or skin grafts on the thorax. Patients with elevated intracranial pressure or acute head and neck injuries require careful consideration and medical guidance.
Preparing the Environment and Patient
The success of Chest Physiotherapy depends significantly on proper preparation of both the patient and the environment. Timing the session correctly is important to prevent complications like nausea and vomiting, so CPT should ideally be performed before meals. If the patient has just eaten, the caregiver should wait at least one to two hours.
The environment should be comfortable, private, and warm to encourage relaxation. Necessary supplies must be gathered beforehand, including pillows, wedges, tissues, and a sputum container. The patient should wear loose clothing that does not restrict breathing, and the area being treated should be covered with a thin layer of fabric or a towel.
Ensuring the patient is adequately hydrated before the session helps thin the mucus, making it easier to mobilize and cough up. The caregiver should wash their hands thoroughly before beginning treatment to minimize the risk of infection.
Step-by-Step Manual Techniques
Chest Physiotherapy relies on three core manual techniques—postural drainage, percussion, and vibration—to effectively mobilize secretions.
Postural Drainage
Postural drainage is the foundational step that uses gravity to direct mucus from smaller lung segments toward the larger central airways. The patient is positioned so the targeted lung segment is perpendicular to the floor, allowing gravity to assist secretion movement. Common positions include lying on the side, slightly rotated, or lying supine or prone with the hips elevated 10 to 20 degrees higher than the chest.
The patient should remain in each position for three to five minutes, or up to 10 minutes. Deep, slow breathing should be encouraged during this time to help expand the lungs and loosen the secretions.
Percussion
Percussion, often called clapping, is performed over the targeted lung segment while the patient is in the drainage position. This involves rhythmic striking of the chest wall with a cupped hand. The cupped hand traps a cushion of air, creating a hollow, popping sound, which transmits a mechanical energy wave to shake the mucus loose from the bronchial walls.
Clapping should be executed rhythmically for three to five minutes over the specific area being drained. Avoid percussing directly over sensitive areas, including the spine, sternum, kidneys, and female breast tissue. Mechanical percussors or handheld rubber cups can be used if manual percussion is difficult or contraindicated.
Vibration
Vibration is the final technique, applied immediately after percussion to move loosened secretions toward the main airways. The caregiver places flattened hands firmly over the area and applies a gentle, fine, oscillating movement. Vibration is applied only during the patient’s exhalation phase, with the hands applying slight compression to the chest wall. The typical sequence involves positioning, followed by three to five minutes of percussion, and then several cycles of vibration over the same segment.
Monitoring Patient Response and Completing the Session
Throughout the Chest Physiotherapy session, continuous monitoring of the patient is necessary to ensure safety and tolerance. The caregiver should watch for signs of adverse response, such as sudden shortness of breath, dizziness, or increased pain. Any change in skin color, such as paleness or a bluish tint, or instability in vital signs like heart rate or blood pressure, requires immediate cessation of the procedure.
After each treated lung segment, the patient must be encouraged to cough to fully clear the mobilized secretions. A “huff” cough is often more effective than a traditional cough because it helps prevent the airways from collapsing during exhalation. To perform a huff, the patient takes a medium-sized breath and then forcibly exhales with the mouth open, as if trying to fog a mirror.
The session concludes once all prescribed lung segments have been treated and the patient has successfully cleared the mobilized mucus. Following the session, the patient should be allowed a period of rest, as the process can be tiring. The caregiver should observe the amount, consistency, and color of the sputum cleared, as this information tracks the treatment’s effectiveness over time.