Notes on the Nature, Forms and Efficacy of Chest Therapy

Dr. Majid Kirmani

Chest physiotherapy (Chest PT) is a treatment for chest disease patients like COPD, Bronchiectasis, ABPA and so on. It is performed by a chest physiotherapist or pulmonary rehab therapist. There are postgraduate degrees in Physiotherapy like MPT Cardio-Thoracic Physiotherapy or MPT Cardio-Pulmonary Physiotherapy. Chest PT includes different types of exercises and techniques to clear the mucus secretions from the lungs and improve the overall lung function of a patient. It also helps to strengthen the respiratory muscles ( muscles used for breathing). Chest Physiotherapy should go side by side with the Pulmonologist’s treatment. Chest PT plays a wonderful role in overall Pulmonary Rehabilitation. Regular Chest PT can improve quality of life of Pulmonary disease patients.
In COPD patients (Asthma, Chronic Bronchitis, Emphysema) and other diseases like Bronchiectasis, Cystic Fibrosis and so on there can be excessive mucus secretions in lungs. These secretions can result in difficulty in breathing or can cause a chest infection. So to clean up the respiratory system, Chest PT plays a vital role. It helps the patient breathe more comfortably and to get more oxygen into the body. Usually a COPD patient uses accessory muscles for breathing that can result in tiredness and loss of energy in the patient. The physiotherapist can train the patient to use proper muscles for breathing and also strengthen the same. Thus the patient can feel more relaxed and can feel more energetic. Chest Physiotherapy is used for patients of all age groups from babies to elderly people.
Once a Physiotherapist teaches the different exercises to a patient, he/she can do these of his/her own. These are very easy and simple to understand and to perform. Some techniques can be taught to the patient’s attendants or parents (in case the patient is a child) and they can perform these at home.
Chest Physiotherapy includes following Exercises and techniques:-
1. Pursed lip breathing.
2. Deep breathing.
3. Huff coughing.
4. Coordinated breathing.
5. Diaphragmatic breathing.
6. Postural Drainage.
1. Pursed lip breathing:
Pursed lip breathing helps the patient to breathe easy and to reserve energy. It helps to release air trapped in the lungs thus promoting relaxation and easing breathlessness.
Procedure:
Close your mouth and take a deep breath in through your nose and count up to 2, don’t breathe deep. Purse your lips, that is, put your lips together as if you are starting to whistle or blow out a candle. This is known as “pursing” your lips. Next breathe out slowly through your mouth and count upto 4 without exerting our using force. You can repeat this process 4 times in a day.
2. Deep breathing:
Deep breathing prevents air from getting trapped in your lungs, which otherwise can cause breathlessness. With deep breathing exercise , you can breathe in more fresh air.
Procedure:
Sit or stand with your elbows bent 90 degrees and slightly back so that you can expand your chest to maximum. Inhale deeply through your nose, hold your breath and count up to 5. Release the air slowly and exhale deeply through your mouth, till all the air in your lungs is released out. This exercise can be practiced many times in a day.
3. Huff coughing:
Huffing is the best way to get rid of mucus from your lungs without exerting too much. This coughing technique relieves a COPD patient from mucus without getting tired.
Procedure:
You can sit comfortably on a chair. Take a deep breath through your mouth, count till 4. Breathe out through your mouth using your stomach muscles making a sound like Hah Hah Hah. This will push the mucus from lower tracks to upper respiratory track.
4. Coordinated breathing:
To prevent breathlessness during physical activity or during general exercises coordinated breathing can help. This type of breathing exercise can also be practiced while climbing stairs or doing any exercises like lifting dumbbells.
Procedure:
Breathe in through your nose before starting an exercise. Purse your lips and breathe out through your mouth when you are lifting a weight like a dumbbell etc. This exercise can also help in relieving anxiety.
5. Diaphragmatic breathing:
Diaphragmatic breathing is also known as abdominal breathing or belly breathing. The diaphragm is an important muscle involved in the work of breathing. COPD patients use their accessory muscles of the neck, shoulders and back to breathe more as compared to the diaphragm. This type of exercise helps to retrain the diaphragm to work more effectively. This putting less stress on the accessory muscles and makes the breathing effortless for a patient.
Procedure:
You can lie down or sit to perform this exercise. Relax your shoulders and put one hand on your chest and the other hand on your stomach. Breathe in through your nose and count upto 3. You’re doing the activity correctly if your stomach moves more than your chest. Purse your lips and breathe out slowly through your mouth, pressing lightly on your stomach. This will enhance your diaphragm’s ability to release air. You can repeat this exercise many times in day.
6. Postural Drainage:
In respiratory diseases like Bronchiectasis, ABPA and Cystic Fibrosis etc there is excessive mucus secretion that causes difficulty in breathing and also caused lung infections. Postural drainage is an lung clearance technique that helps COPD patients to clear mucus from their lungs. The more the lungs are free of excess mucus more the patient feels better and less are the chances of getting lung infections. The lungs consist of five lobes, three on the right side and two on the left side of the rib cage. Each lobe is further divided into many segments. The Postural Drainage helps in draining the mucus from lung segments to upper respiratory tract so the it can be coughed up easily by the patient.
Postural Drainage is a combination of percussion (a clapping movement performed with cupped hands) and vibration (a vibrating movement done with flat hands).
Procedure:
1. Chest percussion is done by making cupped hand and clapping both hands one after other on the patient’s chest wall, moving the wrists only. There should be minimal or no movement in elbows or shoulders of the therapist. Make sure that your hands are cupped not flat as flat hands can not release the mucus and can hurt the patient. You can use good amount of force but the exercise must be pain free for both the patient and the therapist. The technique lies in making perfect cup shape of therapists hand. You will hear a hollow sound in each clapping. The therapist or caregiver should concentrate on ribs and avoid clapping over vertebrae (backbone), sternum (breast bone) and lower back as this can cause fracture or internal organ injury.
2. Vibration therapy is done along with chest percussion , that is, after few minutes of percussion you can use technique that helps to move the mucus to larger airways. In vibration technique the therapist places a flat hand over the chest wall area covering the lung segment that is being drained. Then force can be applied to the chest wall like a vibration machine thus vibrating the chest cavity. During vibration therapy the patient should inhale deeply and exhale slowly but forcefully. This will clear up all the mucus from the lung segments.
Precautions:
1. All these exercises should be done under the supervision of a chest Physiotherapist or a chest Physician.
2. Preferably all these exercises should be done before taking any meals or after a good gap post meals.
3. In case of nausea, vomiting or heamoptasis( coughing up blood) you should stop the exercises and contact your physiotherapist.
4. Using a respiratory device like acapellaor nebuliser before chest exercises will give better results.
5. Postural Drainage should be avoided in cases like pleural effusion, Pulmonary edema, Heart failure, Hypertension, Lung cancer.
6. Postural Drainage is contraindicated in Pulmonary fibrosis, Pulmonary embolism, Increased intracranial pressure, Empyema, Recent chest trauma/rib fracture.

—The author is a Physiotherapist at District Hospital Baramulla. He can be reached at:
majidkirmani@gmail.com