Chest physiotherapy to enhance breathing

When your lungs are healthy and clear, breathing is easy. Occasionally, you may need to cough, which protects your lungs by getting rid of mucus and any foreign matter.

Your lungs normally have a thin layer of mucus that picks up any particles as it’s moved across the lung tissues by tiny hairs called cilia. Mucus moves gradually toward the trachea and larynx where it can be swallowed or expectorated (spit out).

When mucus becomes too thick or sticky because of a disease or condition, coughing alone may not be enough to get rid of it. When that happens, your Advocate doctor may recommend chest physiotherapy to help get rid of the mucus in your lungs.

What is chest physiotherapy?

Chest physiotherapy uses various methods to loosen the mucus in your lungs so it’s easier to cough up.

Conventional or traditional chest physiotherapy techniques were first used for respiratory health more than 100 years ago. Traditional methods use postural drainage, percussion and vibration (PDPV) followed by coughing to help move mucus out of your lungs. Here are descriptions of the elements of PDPV.

• Percussion is provided by a therapist using their cupped hand to rhythmically hit your back in the area of the lungs starting from the bottom and gradually working their way up.
• Vibration is produced using an open hand against your back and gently moving the hand back and forth to loosen mucus.
• Postural drainage is achieved by putting you in different positions depending on the location of the mucus in your lungs. The different positions make use of gravity to help mucus move toward your throat. Before the posture changes begin, your therapist will listen to your lungs using a stethoscope to find the area of mucus that needs to be drained.

The percussion technique of chest physiotherapy is sometimes taught to family members of people who may need it. In addition, bronchodilator therapy is often used with chest physiotherapy to improve results. Effective chest physiotherapy techniques may be used as part of pulmonary rehabilitation to recover from lung conditions.

Other breathing techniques

Your doctor or therapist may recommend that you learn to use forced expiratory technique (FET) instead of coughing. Sometimes known as huffing, forced expiratory technique uses a pattern of breathing in and then forcefully breathing out through your mouth. Research shows these breathing exercises are more effective than coughing for removing mucus from the lungs.

The forced expiratory technique is also used as part of the active cycle of breathing technique (ACBT). You can do ACBT on your own after being taught its methods of breathing control and chest expansion combined with forced expiratory technique.

Chest physiotherapy devices

Based on experience and research, methods have been developed that use different devices to help clear thick or sticky mucus from your lungs. For example, using a chest physiotherapy vest can provide percussion to loosen mucus. Other devices produce pressure to provide lung function improvement. Some of the more common devices are:

• Positive expiratory pressure (PEP): Devices that allow inhaling with no pressure but apply pressure against any exhalation. With practice, they increase the amount of air you can exhale so you remove more mucus at the same time.
• Continuous positive airway pressure (CPAP): Familiar devices used to treat sleep apnea can also be used to apply pressure against exhalations. When used repeatedly, they increase the volume of air and mucus you can exhale.
• High-frequency chest wall oscillation (HFCWO): Chest physiotherapy vests or wraps that inflate and deflate in a steady rhythm to loosen mucus in the lungs. May be used with a nebulizer.
• Intrapulmonary percussive ventilation (IPV): Device uses a mouthpiece to deliver timed bursts of pressurized air into the lungs while the flow of air also helps remove mucus.

Conditions that benefit from chest physiotherapy

Chest physiotherapy techniques are used for people who have lung or neuromuscular conditions that limit lung function such as:

• Chronic obstructive pulmonary disease (COPD)
• Bronchiectasis
• Pneumonia
• Cystic fibrosis
• Muscular dystrophy
• Cerebral palsy
• Spinal cord injury

They may also be used before certain upper abdominal surgeries.

Reasons for chest physiotherapy

Your doctor will decide whether you might benefit from airway clearance techniques based on:

• How much mucus you cough up from your lungs
• Whether your coughing is effective in bringing up mucus
• History of successful postural drainage treatment
• Evaluation of the sounds of your breathing
• Changes in your vital signs
• Abnormal chest X-rays
• Worsening of oxygen levels in your blood

Risks of chest physiotherapy

Different kinds of chest physiotherapy can be effective in restoring the health of your lungs and allowing you to breathe easier. However, there are some risks associated with these techniques. Some people develop low levels of oxygen in the blood (hypoxemia). There may be pain or an injury to the ribs, spine or muscles. Some other potential complications are:

• Spasms in the bronchial tubes
• Increased pressure in the head
• Sudden low blood pressure
• Hemorrhage in lungs
• Vomiting
• Abnormal heart rhythms

Your health care team at Advocate will monitor you carefully during chest physiotherapy and respond quickly if you have any signs of complications.

Benefits of chest physiotherapy

All these airway clearance techniques may improve your respiratory health and quality of life. They provide:

• Improved coughing to expel mucus
• Reduced difficulty with breathing
• Improved physical fitness
• Prevention of secondary respiratory complications
• Lung function improvement

If you have breathing problems, your doctor will let you know if you might benefit from chest physiotherapy.