Skip to main content
SpringerLink
Log in

The role of chest physiotherapy in mucus hypersecretion

  • Management Of Chronic Airflow Obstruction
  • Published:
Lung Aims and scope Submit manuscript

Abstract

Review of the data shows that chest physiotherapy (CP) is effective in clearing secretions from the lungs of patients with copious secretions (i.e., daily sputum production in excess of 30 ml). Assessment of the various components of CP shows that percussion, vibratory shaking, and breathing exercises have little to offer. Although instructed cough, the back up mucus clearance mechanism, is effective in clearing secretions its effect is less than that achieved with the forced expiration technique (FET). Postural drainage (PD) is on the whole successful in helping to drain secretions in the lungs. The administration of aβ 2-agonist via a nebulizer prior to CP in addition to promoting bronchodilation may also help to alter the physical properties of secretions, rendering them more amenable for clearance by FET/cough. Technology regarding high-frequency oscillations (HFO) has yet to be improved and its efficacy in clearing excess secretions proven prior to its inclusion in a CP treatment regimen. Intermittent positive pressure breathing (IPPB) may have a role to play in those patients where conventional CP is not possible. Data with positive expiratory pressure (PEP) are encouraging and direct evaluation is awaited regarding its effect on mucus clearance. With our present knowledge it seems reasonable to recommend that physiotherapists concentrate their CP treatment on the following: administration of a nebulizedβ 2-agonist followed by PD and FET.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Agnew JE, Pavia D, George RJD, Francis RA, Lopez-Vidriero MT, Geddes DM, Clarke SW (1988) Regional mucus transport in cystic fibrosis: effect of physiotherapy manoeuvres. Eur Respir J 1 (Suppl 1):1035

    Google Scholar 

  2. Bateman JRM, Newman SP, Daunt KM, Pavia D, and Clarke SW (1979) Regional lung clearance of excessive bronchial secretions during chest physiotherapy in patients with stable chronic airways obstruction. Lancet i:294–297

    Article  Google Scholar 

  3. Bateman JRM, Newman SP, Daunt KM, Sheahan NF, Pavia D, Clarke SW (1981) Is cough as effective as chest physiotherapy in the removal of excessive tracheobronchial secretions? Thorax 36:683–687

    Article  PubMed  CAS  Google Scholar 

  4. de Boek C, Zimman R (1984) Cough versus chest physiotherapy. A comparison of the acute effects in pulmonary function in patients with cystic fibrosis. Am Rev Respir Dis 129:182–184

    Google Scholar 

  5. Cammer P, Mossber B, Phillipson K, Strandberg K (1979) Elimination of test particles from the human tracheobronchial tree by voluntary coughing. Scand J Respir Dis 60:56–62

    Google Scholar 

  6. Cherniack RM (1980) Physical therapy. Am Rev Respir Dis 122:25–27

    PubMed  CAS  Google Scholar 

  7. Clarke SW (1973) The role of two phase flow in bronchial clearance. Bull Physiopathol Respir 9:359–372

    CAS  Google Scholar 

  8. Currie DC, Munro C, Gaskell D, Cole PJ (1986) Practice, problems and compliance with postural drainage: a survey of chronic sputum producers. Br J Dis Chest 80:249–253

    Article  PubMed  CAS  Google Scholar 

  9. Currie DC, Gaskell D, Cole PJ (1987) The unacceptable face of tipping. Br Med J 294:1613

    Article  CAS  Google Scholar 

  10. Darrow G, Anthonisen NR (1980) Physiotherapy in hospitalized medical patients. Am Rev Respir Dis 122 (part 2 of 2 parts):155–158

    PubMed  CAS  Google Scholar 

  11. Denton R (1962) Bronchial secretions on cystic fibrosis: the effects of treatment with mechanical percussion vibration. Am Rev Respir Dis 86:141–146

    Google Scholar 

  12. Falk M, Kelstrup M, Andersen JB, Kinoshita T, Falk P, Stouring S, Gothgen I (1984) Improving the ketchup bottle method with positive expiratory pressure, PEP, in cystic fibrosis. Eur J Respir Dis 65:423–432

    PubMed  CAS  Google Scholar 

  13. George RJD, Johnson MA, Pavia D, Agnew JE, Clarke SW, Geddes DM (1985) Increase in mucociliary clearance in normal man induced by oral high frequency oscillation. Thorax 40:433–437

    Article  PubMed  CAS  Google Scholar 

  14. van Hengstum M, Festen J, Beurskens C, Hankel M, Beeckman F, Corstens F (1988) Conventional physiotherapy and forced expiration manoeuvres have similar effects on tracheobronchial clearance. Eur Respir J 1:758–761

    PubMed  Google Scholar 

  15. Jones JG, Clarke SW (1970) Dynamics of cough. Br J Anaesth 42:280–285

    Article  PubMed  CAS  Google Scholar 

  16. King M, Phillips DM, Gross D, Vartian V, Chang HK, Zidulka A (1983) Enhanced tracheal mucus clearance with high frequency chest wall compression. Am Rev Respir Dis 128:511–515

    PubMed  CAS  Google Scholar 

  17. King M, Phillips DM, Zidulka A, Chang HK (1984) Tracheal mucus clearance in high-frequency oscillation. II: Effect of wall versus mouth oscillation. Am Rev Respir Dis 130:703–706

    PubMed  CAS  Google Scholar 

  18. Kirilloff LH, Owens GR, Rogers RM, Mazzocco MC (1985) Does chest physical therapy work? Chest 88:436–444

    Article  PubMed  CAS  Google Scholar 

  19. Langlands J (1967) The dynamics of cough in health and in chronic bronchitis. Thorax 22:280–285

    Article  Google Scholar 

  20. Leith DE (1968) Cough. Phys Ther 48:439–447

    PubMed  CAS  Google Scholar 

  21. McEvoy RD, Davies NJH, Hedemstierna G, Hartman MT, Spragg RG, Wagner PD (1982) Lung mucociliary transport during high-frequency ventilation. Am Rev Respir Dis 126:452–456

    PubMed  CAS  Google Scholar 

  22. March H (1971) Appraisal of postural drainage for chronic obstructive pulmonary disease. Arch Phys Med Rehab 52:528–530

    CAS  Google Scholar 

  23. Maxwell M, Richmond A (1979) Comparative trial of manual and mechanical percussion technique with gravity assisted bronchial drainage in patients with cystic fibrosis. Arch Dis Child 54:542–544

    Article  PubMed  CAS  Google Scholar 

  24. Mazzoco MC, Owens GR, Kirilloff LH, Rogers RM (1985) Chest percussion and postural drainage in patients with bronchiectasis. Chest 88:360–363

    Article  Google Scholar 

  25. Murphy MB, Concannon D, Fitzgerald MX (1983) Chest percussion: help or hindrance to postural drainage? Ir Med J 76:189–190

    PubMed  CAS  Google Scholar 

  26. Oldenburg FA Jr, Dolovich MB, Montgomery JH, Newhouse MT (1979) Effects of postural drainage, exercise, and cough on mucus clearance in chronic bronchitis. Am Rev Respir Dis 120:739–745

    PubMed  Google Scholar 

  27. Pavia D, Thomson ML, Philipakos D (1976) A preliminary study of the effect of a vibrating pad on bronchial clearance. Am Rev Respir Dis 113:92–96

    Google Scholar 

  28. Pavia D, Bateman JRM, Clarke SW (1980) Deposition and clearance of inhaled particles. Bull Eur Physiopathol Respir 16:335–366

    PubMed  CAS  Google Scholar 

  29. Pavia D (1984) Lung mucociliary clearance. In: Clarke SW, Pavia D (eds) Aerosols and the lung: clinical and experimental aspects. Butterworths, London, pp 127–155

    Google Scholar 

  30. Pavia D, Agnew JE, Clarke SW (1987) Cough and mucociliary clearance. Bull Eur Physiopathol Respir 23 (Suppl 10):415–455

    Google Scholar 

  31. Pavia D, Webber B, Agnew JE, Vora H, Lopez-Vidriero MT, Clarke SW, Branthwaite MA (1988) The role of intermittent positive pressure breathing (IPPB) in bronchial toilet. Eur Respir J 1 (Suppl 2) 250s

  32. Peters RM, Turner E (1980) Physical therapy. Indications for an effects in surgical patients. Am Rev Respir Dis 122 (part 2 of 2 parts): 147–154

    PubMed  CAS  Google Scholar 

  33. Pryor JA, Webber BA, Hodson ME, Batten JC (1979) Evaluation of the forced expiration technique as an adjunct to postural drainage in treatment of cystic fibrosis. Br Med J 2:417–418

    Article  PubMed  CAS  Google Scholar 

  34. Puchelle E, Zahm Z-M, Girard F, Bertrand A, Polu JM, Aug F, Sadoul P (1980) Relationship to sputum properties in chronic bronchitis. Eur J Respir Dis 61:254–264

    PubMed  CAS  Google Scholar 

  35. Rochester DF, Goldberg SK (1980) Techniques of respiratory physical therapy. Am Rev Respir Dis 122 (part 2 of 2 parts):133–146

    PubMed  CAS  Google Scholar 

  36. Rossman CM, Waldes R, Sampson D, Newhouse MT (1982) Effect of chest physiotherapy on the removal of mucus in patients with cystic fibrosis. Am Rev Respir Dis 126:131–135

    PubMed  CAS  Google Scholar 

  37. Sackner MA, Silva G, Banks JM, Watson DD, Smoak WM (1974) Distribution of ventilation during diaphragmatic breathing in obstructive lung disease. Am Rev Respir Dis 109:331–337

    PubMed  CAS  Google Scholar 

  38. Scherer PW (1981) Mucus transport by cough. Chest 80:830–833

    Article  PubMed  CAS  Google Scholar 

  39. Selsby DS (1989) Chest physiotherapy may be harmful in some patients. Br Med J 298:541–542

    Article  CAS  Google Scholar 

  40. van der Schans CP, Piers DA, Postma DS (1986) Effect of manual percussion on tracheobronchial clearance in patients with chronic airflow obstruction and excessive tracheobronchial secretion. Thorax 41:448–452

    Article  PubMed  Google Scholar 

  41. Sutton PP, Parker RA, Webber BA, Newman SP, Garland N, Lopez-Vidriero MT, Pavia D, Clarke SW (1983) Assessment of the forced expiration technique, postural drainage and directed coughing in chest physiotherapy. Eur J Respir Dis 64:62–68

    PubMed  CAS  Google Scholar 

  42. Sutton PP, Lopez-Vidriero MT, Pavia D, Newman SP, Clay MM, Webber B, Parker RA, Clarke, SW (1985) Assessment of percussion, vibratory-shaking and breathing exercises in chest physiotherapy. Eur J Respir Dis 66:147–152

    PubMed  CAS  Google Scholar 

  43. Sutton PP (1988) Chest physiotherapy: time for reappraisal. Br J Dis Chest 82:127–137

    Article  PubMed  CAS  Google Scholar 

  44. Sutton PP, Gemmell HG, Innes N, Davidson J, Smith FW, Legge JS, Friend JAR (1988) Use of nebulised saline and nebulised terbutaline as an adjunct to chest physiotherapy. Thorax 43:57–60

    Article  PubMed  CAS  Google Scholar 

  45. Thompson BJ (1973) The physiotherapist’s role in the rehabilitation of the asthmatic. NZ J Physiother 4:11–16

    Google Scholar 

  46. Thomson ML, Pavia D, Jones CJ, McQuiston TAC (1975) No demonstrable effect of S-carboxymethylcysteine on clearance of secretions from the human lung. Thorax 30:669–673

    Article  PubMed  CAS  Google Scholar 

  47. Tonnesen P, Stouring S (1984) Positive expiratory pressure (PEP) as lung physiotherapy in cystic fibrosis: a pilot study. Eur J Respir Dis 65:419–422

    PubMed  CAS  Google Scholar 

  48. Verboon JML, Bakker W, Sterk PJ (1986) The value of the forced expiration technique with and without postural drainage in adults with cystic fibrosis. Eur J Respir Dis 69:169–174

    PubMed  CAS  Google Scholar 

  49. Wanner A (1984) Does chest physical therapy move airway secretions? Am Rev Respir Dis 130:701–702

    PubMed  CAS  Google Scholar 

  50. Webber BA, Hofmeyr JL, Morgan MDL, Hodson ME (1986) Effects of postural drainage, incorporating the forced expiration technique, on pulmonary, function in cystic fibrosis. Br J Dis Chest 80:353–359

    Article  PubMed  CAS  Google Scholar 

  51. Wolff RK, Dolovich MB, Obminski G, Newhouse MT (1977) Effects of exercise and eucapnic hyperventilation on bronchial clearance in man. J Appl Physiol 43:46–50

    PubMed  CAS  Google Scholar 

  52. Wollmer P, Ursing K, Midgren B, Erikson L (1985) Inefficiency of chest percussion in the physical therapy of chronic bronchitis. Eur J Respir Dis 66:233–239

    PubMed  CAS  Google Scholar 

  53. Wong JW, Keens TG, Wannamaker EM, Douglas PT, Crozier N, Levison H, Aspin N (1977) Effects of tracheal mucus transport rates in normal subjects and in patients with cystic fibrosis. Pediatrics 60:146–152

    PubMed  CAS  Google Scholar 

  54. Woodhead M, Tattersfield A (1987) The unacceptable face of tipping. Br Med J 294:921–922

    Article  CAS  Google Scholar 

  55. Zach MS, Purrer B, Oberwaldner B (1981) Effect of swimming on forced expiration and sputum clearance in cystic fibrosis. Lancet ii:1201–1203

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Clinical Research, Medical Division, Boehringer Ingelheim (UK) Ltd., Bracknell, Berkshire, United Kingdom

    Demetri Pavia

Authors
  1. Demetri Pavia
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Pavia, D. The role of chest physiotherapy in mucus hypersecretion. Lung 168 (Suppl 1), 614–621 (1990). https://doi.org/10.1007/BF02718185

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02718185

Key words

Search

Navigation