What is Chest Physiotherapy?

Chest Physiotherapy or CPT is a technique that is used to drain the lungs of excess mucus. It is used as a treatment for a lot of respiratory conditions such as chronic obstructive pulmonary disease (COPD) and bronchiectasis. In more recent times, studies have shown that it has been successfully used in Covid-19 cases to prevent the need for artificial ventilators. 

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It is most commonly used in the case of cystic fibrosis, which is a genetic condition that causes lung infections and restricts one’s ability to breathe over a period of time. The mucus becomes thick and sticky, and it causes the airways of the lungs to clog up. Germs and bacteria are also trapped, which causes infections and inflammation. 

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Purpose of Chest Physiotherapy

CPT is generally performed to loosen up and expel mucus that is excess. This is done so that the mucus doesn’t build up in the lungs to cause problems such as cystic fibrosis. There are also aims of removal of blocked airways and airway secretions. 

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The lung compliance is maintained so that it doesn’t collapse either. Another aim is to optimize the gas exchange process. 

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If the objectives of chest physiotherapy are achieved well, an increase in local lung expansion should take place. It should also create a parallel increase in perfusion to the affected area. When secretions are cleared from the larger airways, airways resistance and obstruction should all decrease as well. 

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Smaller airways when cleared should help facilitate lung compliance. By the end of all the treatments, if both large and smaller airways are successfully cleared up, then the work of breathing and oxygen consumption should decrease, and gas exchange should improve. Furthermore, if these objectives are achieved, the incidence of postoperative respiratory infections, morbidities, and hospital stays for those with acute and chronic lung diseases should be reduced. 

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Chest Physiotherapy Techniques

There are various physiotherapy treatments that are incorporated within physiotherapy. Some of them are talked about below.

Diaphragmatic breathing

If the diaphragm is functioning properly then the oxygen consumption of the muscles is low and breathing is regulated easily. If the muscles are necessary to cause inspiration to occur then the work of breathing increases. Patients can be taught breathing control by the optimal use of the diaphragm. Controlled breathing techniques are designed to improve the efficiency of ventilation, decrease the work of breathing, increase the excursion of the diaphragm and improve gas exchange.

Incentive spirometry

This method involves the active maneuver towards maximal inspiration. The patient inhales through a spirometer that is able to provide visual or auditory feedback when the patient breathes in as deeply as they can. 

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Glossopharyngeal breathing

This is usually done when there is a severe weakening of the muscles which allows for inspiration to occur, by increasing the patient’s inspiratory capacity. It helps patients who struggle to take a deep breath in preparation for things like coughing. It is seen that patients with a spinal cord injury are taught this since they are at a higher risk to develop respiratory complications. 

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Pursed lip breathing

This is a useful procedure, associated with gentle-lip breathing with controlled expiration. It keeps airways open by creating back pressure in airways. It is seen to be used with patients with chronic obstructive pulmonary disease (COPD). What it does is that it decreases the respiratory rate and increases tidal volume, while building tolerance for more complex exercises. 

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Postural drainage

This involves positioning the patient with the assistance of gravity, to aid the normal airway clearing mechanism. It is the drainage of the secretions from one or more lung segments to the central airways where they can be removed via a cough or mechanical aspiration. Manual techniques such as percussion, vibration as well voluntary coughing  are used. 

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Percussion

Also known as cupping, clapping, and tapotement, the purpose of percussion is to intermittently apply kinetic energy to the chest walls and lungs. This is done by rhythmically striking the thorax with a cupped hand or mechanical device directly over the lung segment(s) that are being drained. 

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Conditions Treated with Chest Physiotherapy

It is generally suggested to patients who are unable to cough to clear thick localized secretions, as is seen in the cases of:

• Asthma
• Bronchitis
• Chronic obstructive pulmonary disease
• Bronchiectasis
• Lung abscess
• Atelectasis
• Pneumonia
• Cystic fibrosis
• Emphysema
• 
  

Chest Physiotherapy Contraindications

In most cases, the following are taken into consideration:

• Unstable angina, cardiac arrhythmias: An erratic heartbeat is referred to as cardiac arrhythmia. Heart rhythm issues (heart arrhythmias) develop when the electrical signals that coordinate the heart's beats malfunction. 
• Unstable vitals such as blood pressure, pulse, SPO2
• Lung tumors
• Recent myocardial infarction -Also called a heart attack, it is a matter of major concern before physiotherapy. 
• Bleeding
• Suspected or known active pulmonary tuberculosis
• Head and neck injuries
• Elevated intracranial pressure
• Pulmonary embolism
• Surgical wounds
• Rib fractures
• Uncontrolled hypertension
• Subcutaneous emphysema

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