Chest physiotherapy (CPT) is treatment generally performed by physical therapists and respiratory therapists, whereby breathing is improved by the indirect removal of mucus from the breathing passages of a patient.
We have many respiratory conditions that affect the breathing pattern of person such as:
- Asthma: The airways are persistently inflamed, and may occasionally spasm, causing wheezing and shortness of breath. Allergies, infections, or pollution can triggerasthma’s symptoms.
- Chronic obstructive pulmonary diseases (COPD): Lung conditions defined by an inability to exhale normally, which causes difficulty breathing.
- Chronic bronchitis: A form of COPD characterized by a chronic productive cough.
- Emphysema: Lung damage allows air to be trapped in the lungs in this form of COPD. Difficulty blowing air out is its hallmark.
- Acute bronchitis: A sudden infection of the airways, usually by a virus.
- Cystic fibrosis: A genetic condition causing poor clearance of mucus from the bronchi. The accumulated mucus results in repeated lung infections.etc
Therefore once a physiotherapist gets to know the diagnosis and treatment is done in terms of giving the patient bronchodilators, decongestants, corticosteroids, pulmonary surfactant etc. Done by respiratory specialist, the physiotherapist now can start there management, remember the role of a physiotherapist is to work on the musculoskeletal system that is muscles,bones,soft tissue and nerves either by strengthening through exercises ,activation of muscles that are weak therefore the goal of a physiotherapist in chest is the same strengthening respiratory muscles, chest expansion to help in easing breathing without straining is to help patients breathe more freely and to get more oxygen into the body.
Chest Physical therapy Techniques include
Postural drainage the technique involves placing the patient in a position which allows gravity to assist in draining mucus from the periphery of the lungs to the central upper airway as shown in Fig 1&2
Postural drainage is an airway clearance technique that helps people with COPD clear mucus from their lungs. The goal of postural drainage is to help drain mucus from each of these lobes into the larger airways so it can be coughed up more readily.
Chest percussion (chest physiotherapy) uses clapping of the chest with a cupped hand to vibrate the airways in the lungs. This vibration moves the mucus from smaller airways into larger ones where it can be coughed up from the lungs.
Vibration is a technique that gently shakes the mucus so it can move into the larger airways from smaller airways and it is coughed up from the lungs.
Huffing also known as huff coughing, is a technique that helps move mucus from the lungs. It should be done in combination with another ACT. Exhale forcefully, but slowly, in a continuous exhalation to move mucus from the smaller to the larger airways.
Note: In all this techniques you have to consider who is able to do this and who is not that from children, middle age to geriatrics (old people)
What are the contraindications of these techniques?
– A contraindication is a specific situation in which a drug, procedure, or surgery should not be used because it may be harmful to the person
-Recent spinal surgery (i.e., laminectomy)
-Acute spinal injury
-Cardiogenic pulmonary swelling
-Large pleural effusion
-Confused, anxious, or otherwise impaired patients who actively resist or do not tolerate position changes.
-Rib fracture with or without flail chest or other significant
chest injury, neurosurgery, aneurysms, and eye surgery)
-Esophageal or other upper body surgery adversely affected by this position
-Lung carcinoma recently treated by surgery or radiation with actual or significant potential of hemoptysis
-Uncontrolled airway with significant risk of aspiration
(tube feeding or recent meal)
-Recent epidural anesthesia or recent epidural or intrathecal drug administration
-Recent skin grafts or flaps on the thorax.
-Burns, open wounds, and skin infections of the thorax
-Recently placed transvenous or subcutaneous pacemaker
(mechanical vibration and percussion are relatively more contraindicated)
-Suspected or known active pulmonary tuberculosis
– Osteomyelitis of the thorax
-Osteoporosis of the thoracolumbar region
-Coagulopathy or thrombocytopenia (manual vibration may be well tolerated)
-Complaints of chest wall pain
-Absolute: Osteogenesis imperfecta or other bone disease.
-Elevated intracranial pressure or known intracranial aneurysm
-Acute unstable head, neck or spine injury
Reference https:www.bronchiectasis.scot.nhs.uk/chest -physiotherapy