Chest Physiotherapy: All You Need to Know

Chest Physiotherapy is basically physiotherapy to help in the improvement of lung function to help the person breathe better. This is when there is an excess of lung secretion, so physiotherapy is done to help in loosening the secretions.

CPT is to be done only by trained professionals or under specific and direct instructions as doing it wrong can cause complications. In this article, we will look at more about chest physiotherapy, how it is done, why it is done, complications, and a few other aspects of it.

What is Chest Physiotherapy?

CPT helps in loosening thick lung secretions, strengthening the breathing muscles, and also expanding the lungs. CPT is used to help conditions like chronic obstructive pulmonary disease and cystic fibrosis. This will also help in keeping the lungs clear in long periods of immobility or after surgery to help prevent pneumonia.

This is only one method that can be used in the treatment of respiratory diseases. This means that it is recommended that you get a second opinion on your choice for treatment before you go for CPT.

Chest Physiotherapy Procedure

The chest physiotherapy procedure is something that is to be done only by professionals. Otherwise, there is a greater risk of complications occurring that can be very dangerous. In this section, we will look at the different chest physiotherapy techniques:

• Chest percussion and vibration helps in loosening excessive lung secretions. Patients sometimes will have to wear a special CPT vest that will be hooked up to a machine. This machine will cause the vest to vibrate at a high secretion, thereby breaking up the secretions.
• There are controlled coughing techniques that can help in breaking up these lung secretions as well, so the caregiver can easily suction the secretions out, or you may be able to cough them out.
• Exercises with deep breathing help in expanding the lung, and this helps in the lungs being able to draw in air into all its areas.
• Incentive spirometry is used to help in improving lung function by strong inhalation that is done with a device. This can be used post-surgery to prevent pneumonia and also to re-expand the lungs.
• Positioning and turning side to side can greatly help in the improvement of secretion drainage and lung expansion. This is especially essential for those that are hospitalised or bedridden.
• Draining lung secretions can also be done by postural drainage.

Other Procedures that may be Performed for CPT

When it comes to managing respiratory diseases and other breathing problems, doctors may recommend other treatments. Treatments that are recommended will vary based on the disease, the severity of the condition, age, medical history and other such factors. These other treatments may include:

• Suctioning help in removing all those secretions that you are unable to cough out.
• Secretions can be moistened and airways opened with nebuliser treatments.
• Loosening lung secretions to help ease coughing them up can be done with expectorant medicines.

Who Does Chest Physiotherapy?

Chest Physiotherapy Treatment (CPT) is to be done by registered nurses and respiratory therapists as they are trained in this. The latter are healthcare professionals that are trained to assess, care for, and treat patients that have breathing disorders and the like. Depending on the stage of the condition, the nurse or therapist involved may also teach you, your family members or other caretakers the techniques so that they can be done at home.

These are the specialists that administer Chest Physiotherapy Treatment (CPT):

• Pulmonologists

These are paediatricians or internists that have undergone specialised training in the treatment of conditions of the chest like complicated chest infections, emphysema, tuberculosis, asthma, pneumonia, etc.

• Primary Care Providers

They include family practitioners, nurse practitioners, PAs, geriatricians, paediatricians, and internists. These primary care providers give comprehensive healthcare services and treatment for a whole range of conditions and diseases. 

• Hospitalists

They specialise in taking care of patients that have been hospitalised. They include doctors generally but can include a nurse practitioner or physician assistant.

Assessment of Need

Here are some aspects that need to be assessed together to establish the need for CPT:

• Deterioration in the oxygen saturation or arterial blood gas values.
• Changes in the vital signs.
• Decreased sounds of breathing or rhonchi or crackles suggesting that there are secretions in the airways.
• Abnormal chest x-rays that are consistent with infiltrates, mucus plugging, or atelectasis.
• History of pulmonary issues that have been successfully treated with PDT like lung abscess, cystic fibrosis, or bronchiectasis.
• Effectiveness of coughing.
• Excessive production of sputum.

These are some factors that can be used as outcome tools for the caregiver to determine how effective the treatment is

• Peak Expiratory Flow Rate changes.
• Sputum production changes.
• Vital signs change.
• Chest x-ray changes.
• The subjective response of the patient to therapy.
• The breath sounds of lung fields changes.
• The modified bog scale dyspnea level changes.
• The ventilator variables change.
• The oxygen saturation or arterial blood gas value changes.

Chest Physiotherapy Contraindications

In this section, we will look at chest physiotherapy contraindications when it comes to conventional techniques.

Positioning

Positions are contraindicated when it comes to:

• Healing tissue or surgical wounds.
• Rib fractures, be it with our flail chest.
• Anxious, confused or aged patients that will not tolerate or cooperate with position changes.
• Pulmonary embolism.
• Large pleural effusions.
• Bronchopleural fistula.
• Empyema.
• Pulmonary oedema is associated with congestive heart failure.
• Acute hemoptysis or acute spinal injury.
• Active haemorrhage that is alongside hemodynamic instability that is absolute.
• Neck injury or head injury until it is stabilised.
• Intracranial pressure that is (ICP) > 20 mm Hg.

When we talk about the Trendelenburg position, it is contraindicated for:

• Reverse Trendelenburg is contraindicated only when it is vasoactive or hypotension medication.
• The airway is uncontrolled and at risk for aspiration in the context of a recent meal or tube feeding.
• When there is recent gross hemoptysis that is in relation with recent lung carcinoma that was treated with either radiation therapy or surgically.
• Oesophageal surgery.
• Distended abdomen.
• Uncontrolled hypertension.
• Patients that have increased intracranial pressure are to be avoided, for example, in cases of eye surgery, aneurysms, or neurosurgery.

External Manipulation of the Thorax

• Intracranial pressure that is (ICP) > 20 mm Hg

Apart from the listed complications, other things to consider are:

• Complaint of pain in the chest wall.
• Coagulopathy.
• Osteoporosis.
• Osteomyelitis of the ribs.
• Bronchospasm.
• Lung contusion.
• Suspected pulmonary tuberculosis.
• Pacemakers that have been placed recently like subcutaneous pacemakers or transvenous pacemakers, especially if there will be the usage of mechanical devices.
• Skin infections, open wounds, or burns on the thorax.
• Recent flaps or skin grafts on the thorax.
• Recent spinal anaesthesia od epidural spinal infusion.
• Subcutaneous emphysema.

Complications

• Dysrhythmias.
• Bronchospasm.
• Aspiration and vomiting.
• Injury or pain to the spine, ribs, or muscles.
• Pulmonary haemorrhage.
• Acute hypotension while the procedure is happening.
• Increased intracranial pressure.
• Hypoxemia.

Preparing for Chest Physiotherapy

It is important to prepare yourself before you go in for CPT so it can help in the improvement of the outcome of the therapy and also comfort as it is being done.

It is recommended that you do not eat right before CPT happens. Some chest physiotherapy techniques would require drinking water before you take the treatment to help in loosening the lung secretion, and it helps in suction and removal. The respiratory therapist, nurse, or doctor would also give you other instructions that you would want to order before CPT.

Here Are Some Questions that You Should Ask Your CPT Provider:

You may have some questions or queries that you may want to ask regarding CPT or anything else about your condition. However, it is common for patients to forget these questions, and others may occur after the appointment with the doctor. So it is best to write them down so you are prepared and do not forget anything that you may want to ask your doctor. Some common questions about CPT may include:

• Why is there a need for chest physiotherapy? Are there any other options that I can pursue the condition?
• How often do I need CPT, and for how long?
• How and what medication should be taken?
• When should the next follow-up be?
• How can I contact the hospital in case of emergencies or queries during or post regular hours?

Purpose of CPT

Your doctor may recommend that you undergo chest physiotherapy for a purpose to help you cough up or loosen excessive or thick lung secretions. This can happen due to conditions like:

• Atelectasis

This is a condition where some lung tissue or all of them collapse.

• Bronchiectasis

This is where the large airways of the lungs have been widened and even damaged.

• Chronic Obstructive Pulmonary Disease

COPD is a condition that includes chronic bronchitis and emphysema.

• Cystic Fibrosis

This is a disorder that is genetic and can cause a build-up of sticky and thick mucus in the lungs as well as other organs.

• Immobility

This is when there is a low level of activity because of being in a wheelchair or bedridden because of any condition. CPT can help in the prevention of pneumonia or any other breathing issues that can occur because of long-term mobility.

• Lung Infections

This can include lung abscess, acute bronchitis and pneumonia.

• Neuromuscular Diseases

This includes Guillain-Barré syndrome, multiple sclerosis, muscular dystrophy, and cerebral palsy.

• Some Surgeries

Certain surgeries like lung removal or any that make it hard to take in a deep breath can require CPT. Some types of CPT help in the prevention of breathing problems and pneumonia that can occur post-surgery.

Risks

CPT, like any procedure, has some risks that patients need to be aware of. This is regardless of the fact that CPT is usually safe for patients when the techniques used are used appropriately for the condition. However, when the head is lowered, CPT can result in complications like:

• Vomiting.
• Injury or pain in the ribs or spine.
• Low oxygen levels in the blood.
• Low blood pressure.
• Inhalation of secretions into the lungs.
• Feeling increased pressure in the head.
• Cardiac arrhythmia.
• Coughing up blood and bleeding in the lungs.

Another factor to think about is that certain people should not have CPT as they have a higher chance of developing complications. This includes those with:

• Vomiting.
• Uncontrolled or severe pain.
• Haemorrhage.
• Increased pressure in the skull is intracranial pressure or a serious neck or head injury.
• Osteoporosis or vertebral or rib fractures.
• Uncontrolled high blood pressure.
• A recent heart attack.
• Inability in the production of any secretions.
• Open wounds or burns.
• Blood-thinning drug therapy like using anticoagulants.
• Respiratory conditions like lung abscess, pulmonary embolism, pneumothorax, bronchopleural fistula, and asthma.

You can reduce or minimise the chances of complications arising by informing your CPT provider about any symptoms immediately. This can include shortness of breath, nausea, fatigue, dizziness, headache, or pain. It is important to follow the given treatment plan, including the breathing treatments and taking medications regularly and as directed to avoid any complications during CPT.

What to Expect After Chest Physiotherapy

Chest physiotherapy is difficult and can be a very exhausting process. However, you will be able to tolerate it better as your condition begins to improve. If you’re getting tired or exhausted, it is better to tell your provider so that the technique can be adjusted to suit you better. Over time chest physiotherapy will improve energy levels as the amount of oxygen in your blood will increase, and you will be able to breathe a lot easier.

Length of CPT

CPT treatment sessions generally last anywhere between twenty to forty minutes. It is best to have this done before you eat a meal, or if it is after you eat, the time gap should be of at least one to two hours. This can reduce the chances of vomiting during CPT. Early bedtimes and mornings are also recommended with this.

The duration and the frequency of CPT largely depend on the condition and may need to be increased if the patient is getting sick or more congested. The doctor can recommend the positions and the frequency of CPT after assessing the condition.

Comfortable and Careful CPT

Another key factor that should not be ignored while administering CPT is that both the person and the caregiver need to be comfortable while this is happening. Before you begin, it is best if the patient removes any tight clothing or zipper around the chest, neck, and waist, along with removing buttons and jewellery. It is best to wear clothing that is soft and light.

CPT should not be done on bare skin, and the caregiver, too, needs to remove any bulky jewellery like bracelets and watches and even rings. It is best to keep tissues or a bin nearby when the patient needs to cough out mucus.

When percussion is being done, it is best that the caregiver remains in a position that is upright to protect their back, and they should not be leaning forward. The patient, on the other hand, should be lying on a surface that is at a height comfortable for the caregiver.

Most people find it very helpful when they use newspapers under the pillow, sofa cushions, or pillow for supports. Other things that can help are bean bag chairs, foam wedges or cribs where the mattress tilts or the height can be adjusted. Infants can be positioned in the lap of the caregiver with our without pillows.

Conclusion

CPT is one of the treatments that is used to help with respiratory diseases and helps in the prevention of pneumonia, removal of excessive lung secretion and lung expansion. CPT is something that is to be performed by the related healthcare professionals and those they instruct and should never be tried alone. This is to avoid complications that can be very dangerous. The frequency and duration of these sessions are to be decided by the primary healthcare provider alone.

It is important to consult the doctor about any other treatments that may help before you opt for CPT. This is a therapy that helps people of all ages and can greatly help in easing certain conditions like cystic fibrosis, atelectasis, bronchiectasis, chronic obstructive pulmonary disease, lung infections, etc.

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