What is chest physiotherapy?

Chest physiotherapy is a group of physical techniques that improve lung function and help you breathe better. Chest PT, or CPT expands the lungs, strengthens breathing muscles, and loosens and improves drainage of thick lung secretions. Chest PT 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 PT

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.

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

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

Healthcare providers often perform these 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.

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 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 or osteoporosis

Reducing your risk of complications
You can reduce the risk or minimize certain complications by telling your provider right away about any symptoms. Symptoms include pain, headache, dizziness, fatigue, nausea, or shortness of breath. It is also important to follow your treatment plan, including taking medications and breathing treatments as directed.

What can I expect after my chest physiotherapy?

Chest PT is hard work and can be tiring, but you will tolerate therapy better as your condition improves. Tell your provider if you are uncomfortable or tired so the techniques can be adjusted. Over time, chest physiotherapy can help you breathe easier, increase the amount of oxygen in your blood, and improve your energy level.