Chest Physiotherapy

Chest Physiotherapy

Chest physiotherapy (CPT) is a technique used to mobilize or loosen secretions the lungs and respiratory tract. This is especially helpful for patients with large amount of secretions ineffective cough. Chest physiotherapy consists of external mechanical maneuvers, such as chest percussion, postural drainage, vibration, to augment mobilization and clearance of airway secretions, diaphragmatic breathing with pursed-lips, coughing and controlled coughing. 

Purpose: To remove tenacious secretions from bronchial walls in conditions like bronchiectasis and chronic bronchitis.

Deep Breathing and Coughing Exercise

Deep breathing and coughing exercise means exercise and breathing practice for those patients who have or may have impairment of breathing or respiratory functions or it means lungs expansion exercise to be performed by the patient including inhalation and exhalation. Simply breathing exercises are designed to retain the muscles of respiration, improve ventilation, lessen the work of breathing and improve gaseous exchange. Taking deep breath helps to expand alveoli and promotes effective cough which decreases the risk of atelectesis. Deep breathing is useful for all clients, especially post-operative.

Purposes

• To facilitate respiratory functioning by increasing lung expansion and preventing alveoli collapse.
• To promote blood circulation to and from the lungs, thereby preventing pulmonary embolism.
• To prevent complications like infection and atelectasis.
• To loosen and bring out secretions.
• To relieve anxiety by preventing dyspnoea.
• To slow the respiratory rate and decrease the work of breathing.
• To strengthen the abdominal muscles and diaphragm.
• To promote efficient inspiration and expiration of respiratory system.
• To promote relaxation and relieve stress.

Benefits of Breathing Exercises

• Improve ventilation.
• Increase the effectiveness of the cough mechanism.
• Prevent pulmonary impairments.
• Improve the strength, endurance, and coordination of respiratory muscles.
• Maintain or improve chest and thoracic spine mobility.
• Correct inefficient or abnormal breathing patterns.
• Promote relaxation.
• Improve the patient's overall functional capacity.

Indications for Breathing Exercises

It is indicated for patients in whom cough is insufficient to clear thick, tenacious, or localized secretions. Examples include:

• Acute or chronic lung disease
  • Chronic obstructive lungs disease
  • Pneumonia
  • Atelectasis
  • Cystic fibrosis
  • Bronchiectasis
  • Pulmonary embolism
  • Acute respiratory distress
• Pain in the thoracic or abdominal area because of surgery or trauma
• Airway obstruction secondary to bronchospasm or retained secretions
• Severe orthopedic abnormalities such as scoliosis and kyphosis that affects respiratory function
• Stress management and relaxation procedures

Contraindications

• Increased intracranial pressure
• Lungs abscess and tumour
• Unstable head or neck injury
• Active hemorrhage with hemodynamic instability or hemoptysis
• Spinal injury
• Bronchoplueral fistula/pneumothorax
• Uncontrolled hypertension
• Anticoagulation
• Rib or vertebral fractures or osteoporosis

Guidelines

• Never allow a patient to force expiration. Expiration should be relaxed and passive. Forced expiration only increases turbulence in the airways, which can lead to bronchospasm and increased airway restriction.
• Encourage the patient with abdominal or chest surgery to carry out deep breathing and coughing at least three or four times daily and at each session to take a minimum of five breaths.
• Do not allow the patient to take a very prolonged expiration. This causes the patient to gasp with the next inspiration. The patient's breathing pattern then becomes irregular and inefficient.
• Do not allow the patient to initiate inspiration with the accessory muscles and the upper chest. Advise the patient that the upper chest should be relatively quiet during breathing.
• Allow the patient to practice deep breathing for only three or four inspirations and expirations at a time to avoid hyperventilation.

Articles

• Sputum mug
• Kidney tray
• Pillows
• Small towel
• Tissue paper
• Drinking water
• Stethoscope

Procedure

Diaphragmatic Breathing

Diaphragmatic breathing or deep breathing is breathing that is done by contracting the diaphragm, a muscle located horizontally between the thoracic cavity and abdominal cavity. Air enters the lungs and the chest rises and the belly expands during this type of breathing.

Breathing Technique

• Breathe in slowly through your nose so that your stomach moves out against your hand. The hand on your chest should remain as still as possible.
• Place one hand on your upper chest and the other just below your rib cage. This will allow you to feel your diaphragm move as you breathe.watir toge
• Tighten your stomach muscles, letting them fall inward as you exhale through pursed lips (see "Pursed Lip Breathing Technique"). The hand on your upper chest must remain as still as possible.

Benefits

The use of diaphragmatic breathing is commonly practiced, especially in those patients with chronic obstructive pulmonary disease, to improve a variety of factors such as pulmonary function, Decrease the work of breathing by slowing breathing rate, Decrease oxygen demand and, respiratory muscle strength.

Pursed Lip Breathing

Pursed lip breathing is one of the simplest ways to control shortness of breath. It provides a quick and easy way to slow your pace of breathing, making each breath more effective.

Technique

• Sit with back straight or lie down. Relax the shoulders as much as possible.
• Inhale through the nose for two seconds, feeling the air move into abdomen. Try to fill the abdomen with air instead of just your lungs.
• Purse your lips like you're blowing on hot food and then breathe out slowly, taking twice as long to exhale as you took to breathe in.
• Then repeat. Over the time, you can increase the inhale and exhale counts from 2 seconds to 4 seconds, and so on.

Benefits

Pursed lip breathing can help improve and control breathing in several ways, including:

• Relieving shortness of breath by slowing the breath rate.
• Keeping the airways open longer, which decreases the work that goes into breathing.
• Improving ventilation by moving old air (carbon dioxide) trapped in the lungs out and making room for new, fresh oxygen.

Postural Drainage

Postural drainage is the positioning techniques that drain secretions from specific segments of the lugs and bronchi into the trachea. Drainage of secretion from lung segments by gravity utilizing specific positioning techniques is postural drainage. The client is placed in various positions to facilitate mucous flow from different segments of the lung.

Placing a mucous filled segment of the lung higher than the rest of the lungs, allows the mucous in that segment to flow more readily downward towards larger airways. In this way, coughing or suctioning more easily removes the mucous. Not all postural drainage position is well tolerated by all clients. The trendelenburg position can increase shortness of breath in the client with COPD because the abdominal organs limit diaphragm movement lying head down injuries. It can also be very stressful for clients with cardiac problems.

Purposes

• To improve the mobilization and elimination of pulmonary secretion from the bronchioles.
• To aid for easy breathing in bronchial or lobar pneumonia, lung abscess.
• To assist patients who are unable to cough and bring out sputum.
• To treat patients with bronchiectasis, chronic bronchitis and cystic fibrosis.

Indications

• Pre-operative patient with excessive secretion.
• Post-operative patient with ineffective coughing.
• Patient with bronchial or lobar pneumonia.
• Patient with recurrent chest infection.
• Patient with musculoskeletal problem, interfering in coughing mechanism.
• Lung abscess.

Contraindications

• Suspected carcinoma and metastasis
• Bronchospasm is increased during percussion and vibration
• Recent CVA Active hemoptysis
• Pneumothorax
• Tuberculosis
• Large pleural effusion /emphysema
• Pulmonary embolism
• Nose bleeding
• Cardiovascular instability
  • Cardiac arrhythmia
  • Severe hypertension or hypotension
  • Pulmonary edema associated with congestive heart failure
  • Recent myocardial infarction
• Recent neurosurgery
• Painful chest conditions
• Rib fractures
• Lung tumor

Guidelines

• Postural drainage should be done when the patient has an empty stomach. Perform Postural drainage 2 hrs before and after meal.
• Assess the client's medical record for orders regarding activity and position restrictions, tolerance of physiotherapy, and position changes.
• Avoid postural drainage for the patient with hemoptysis.
• Determine the correct position for postural drainage, check the x-ray and listen with stethoscope if there is fluid in lungs.
• Do not percuss on pain site.
• Monitoring a patient's response to postural drainage therapy, before, during and after therapy.
• Avoid postural drainage on the patient with surgical or injured areas and on the patient with unstable vital signs.
• Provide inhalation using bronchodilators 20 minutes before postural drainage for patients at rise of bronchospasm.
• Best times of treatment are:
  •   In the morning before breakfast, when patient can clear secretions that accumulate overnight.
  •   One hour before bed time, so lungs are clear before sleeping and the patient has time after treatment to cough up any mobilized secretions.
• The procedure should be discontinued if tachycardia palpitation, dyspnea or chest pain occurs.
• Assess bilateral breath sounds, noting rate and character.

Articles

• Gloves
• Pillows depending on position
• Sputum mug
• Suction machine / 02 cylinder
• Folding bed
• Tissue paper