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Chest Physiotherapy

By

Catherine Spader, RN

What is chest physiotherapy?

Chest physiotherapy is a group of physical techniques that improve lung function and help you breathe better. Chest physiotherapy expands the lungs, strengthens breathing muscles, and loosens and improves drainage of thick lung secretions. Chest physiotherapy helps treat such diseases as cystic fibrosis and COPD (chronic obstructive pulmonary disease). It also keeps the lungs clear to prevent pneumonia after surgery and during periods of immobility.  

Chest physiotherapy is only one method used to treat respiratory diseases.  Consider getting a second opinion about all of your treatment choices before having chest physiotherapy.

Types of chest physiotherapy

Healthcare providers often use different types of chest physiotherapy together including:

  • Chest percussion to help loosen lung secretions

  • Controlled coughing techniques to help break up lung secretions so your caregiver can suction them out or you can expectorate them

  • Deep breathing exercises to help expand the lungs and draw more air into all areas of the lungs

  • Incentive spirometry to help improve lung function by inhaling strongly using a special device. You may use it after surgery to re-expand your lungs and prevent pneumonia.

  • Positioning and turning from side to side to help improve lung expansion and drainage of secretions. This is important for patients who are bedridden or hospitalized.

  • Postural drainage to help drain lung secretions

  • Vibration to help break up lung secretions

Other procedures that may be performed

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Doctors generally recommend one or more other treatments to manage respiratory disease and breathing problems. Treatments vary depending on the specific disease, the severity of the disease, your medical history, your age, and other factors. Treatments and procedures may include:

  • Expectorant medications to help loosen lung secretions and make them easier to cough up

  • Nebulizer treatments to help moisten secretions and open the airways

  • Suctioning to remove secretions that you can’t cough out

Why is chest physiotherapy performed? 

Your doctor may recommend chest physiotherapy to help loosen and cough up thick or excessive lung secretions from such conditions as:  

  • Atelectasis, in which some or all of your lung tissue collapses

  • Bronchiectasis, in which the large airways in your lungs are damaged and widened

  • COPD (chronic obstructive pulmonary disease), which includes emphysema and chronic bronchitis

  • Cystic fibrosis, which is a genetic disorder that causes thick, sticky mucus build-up in the lungs and other organs

  • Immobility, in which you have a low activity level due to being bedridden or in a wheelchair. Chest physiotherapy can help prevent pneumonia and other breathing problems due to long-term immobility.

  • Lung infections, which include pneumonia, acute bronchitis, and lung abscess

  • Neuromuscular diseases, which include cerebral palsy, muscular dystrophy, multiple sclerosis, and Guillain-Barré syndrome

  • Surgery, which includes major surgery and other procedures that make it difficult to take a deep breath. Some types of chest physiotherapy can help prevent pneumonia and other breathing problems after surgery.

Who performs chest physiotherapy?

A respiratory therapist or nurse performs chest physiotherapy. Respiratory therapists are healthcare professionals who assess, treat and care for patients with breathing disorders. Depending on your condition, the respiratory therapist or nurse may also teach you and your family to perform the techniques at home.

The following specialists often prescribe chest physiotherapy:

  • Hospitalists specialize in caring for hospitalized patients. Hospitalists are usually doctors , but can also be a physician assistant (PA) or nurse practitioner (NP).
     
  • Primary care providers including internists, family practitioners (family medicine doctors), pediatricians, geriatricians, physician assistants (PAs), and nurse practitioners (NPs). Primary care providers offer comprehensive healthcare services and treat a wide range of illnesses and conditions.

  • Pulmonologists are internists or pediatricians with specialized training in treating diseases and conditions of the chest, such as pneumonia, asthma, tuberculosis, emphysema, or complicated chest infections.

How is chest physiotherapy performed?

Your chest physiotherapy will be performed in a hospital, clinic, long-term care facility, or in your home. It is usually done several times a day. Techniques vary depending on age, diagnosis, and general health. Some chest physiotherapy techniques require you to sit up. Others allow you to lie on your back, side or stomach depending on the area of the lungs that need drainage. In some cases, your head will be lower than the chest.  Gravity will encourage drainage.

Nebulizer breathing treatments are often useful to open the airways or moisten, thin, or break up mucus. If your healthcare provider recommends this, you will inhale a mist containing saline (salt water solution) or medications before your chest physiotherapy.

Healthcare providers often perform different chest physiotherapy techniques together including:

  • Chest percussion involves striking the chest wall with cupped hands, often in combination with postural drainage.

  • Controlled coughing techniques involve coughing gently, making short grunting noises, or making two to three sharp staccato coughs with the mouth slightly open. Controlled coughing techniques are done with postural drainage and throughout the day.

  • Deep breathing exercises involve inhaling deeply through the nose and breathing out very slowly through pursed lips.

  • Incentive spirometry involves inhaling through a tube to raise a ball in a sealed chamber. You will need to keep the ball raised for as long as possible.

  • Positioning and turning from side to side involves elevating the head of the bed and turning every one to two hours in bed. This promote drainage of secretions. Caregivers turn patients who cannot turn themselves.

  • Postural drainage involves taking positions that allow gravity to help drain secretions. Postural drainage is often useful with chest percussion and coughing techniques.

  • Vibration involves placing the hands against the patient's chest. The hands create vibrations by quickly contracting and relaxing arm and shoulder muscles while the patient exhales. It is often useful after chest percussion.

Will I feel pain with chest physiotherapy?

Your comfort and relaxation is important to you and your care team. Chest physiotherapy techniques can be tiring and uncomfortable, especially for weak or chronically ill patients. Tell your provider if you are uncomfortable or fatigued. Your provider will adjust the technique to your condition. Your tolerance for chest physiotherapy should improve over time, as you feel better.

What are the risks and potential complications of chest physiotherapy?  

Chest physiotherapy is generally safe for most patients when techniques are appropriate for the patient’s condition. In some cases, such as when the head is lowered, chest physiotherapy can cause the following complications:

  • Bleeding in the lungs and coughing up blood

  • Cardiac arrhythmia (abnormal heartbeats)

  • Increased pressure inside the head

  • Inhaling secretions into the lungs

  • Low blood pressure

  • Low levels of oxygen in the blood

  • Rib or spine pain or injury

  • Vomiting

Certain people have a higher risk of complications and should not have chest physiotherapy including those with:

  • Blood thinning drug therapy (anticoagulants)

  • Burns or other open wounds

  • Inability to produce any secretions

  • Certain respiratory conditions including asthma, bronchopleural fistula, pneumothorax, pulmonary embolism, and lung