Chest Physiotherapy

Chest physiotherapy is a complete group of physical techniques that improvises lungs function and helps you breathe peacefully. Chest PT, or CPT generally expands the lungs, strengthens breathing muscles, and loosens and improves drainage of thick lung secretions. It 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.

Types of chest PT

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

  1. Chest percussion and vibration to help loosen lung secretions. Some patients wear a special CPT vest hooked up to a machine. The machine makes the vest vibrate at high frequency to break up the secretions.
  2. Controlled coughing techniques to help break up lung secretions so your caregiver can suction them out or you can cough them up.
  3. Deep breathing exercises to help expand the lungs and draw more air into all areas of the lungs
  4. 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.
  5. 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.
  6. Postural drainage to help drain lung secretions

Other procedures that may be performed are

  • 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 PT 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)
  • Cystic fibrosis
  • 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
  • Neuromuscular diseases
  • Surgery, which includes lung Removal and other surgeries that make it difficult to take a deep breath.

How is chest physiotherapy performed?

Some chest PT 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).

Different chest PT techniques together:

  • 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 promotes 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. There are also mechanical CPT vests you can wear for high-frequency vibration. Another name for these vests is Airway Clearance System.

Risks and potential complications of chest physiotherapy 

Chest PT 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 abscess
  • Recent heart attack or uncontrolled high Blood Pressure
  • Rib or vertebral fractures
  • Serious head or increased pressure in the skull (intracranial pressure)
  • Severe active bleeding (hemorrhage)
  • Severe or uncontrolled pain
  • Vomiting

How do I prepare for chest physiotherapy?

The steps you take before chest physiotherapy can improve your comfort and outcome. You should not eat right before chest PT. Some techniques require you to drink a glass of water before the treatment to help thin and loosen thick lungs secretions. Your doctor, nurse, or respiratory therapist may give you other instructions to follow before chest PT.

Questions to ask your doctor, respiratory therapist, or nurse

It is common for patients to forget some of their questions about their disease and treatments during a doctor’s visit. You may also think of other questions after your appointment or after you leave the hospital. Contact your doctor with concerns and questions before chest physiotherapy and between appointments.

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