Chest physiotherapy techniques
Chest physiotherapy can provide effective airway clearance through a variety of techniques performed by a trained physiotherapist or even by a caregiver in the comfort of home.
Chest physiotherapy: Percussion and postural drainage
With percussion and postural drainage, a physiotherapist uses gravity to drain mucus from the lungs. They will adjust your body into one of many different positions that faces your lungs downward, before clapping and/or vibrating your chest. This could look like three to five minutes of clapping (with a cupped hand), followed by 15 seconds of vibrating (with a flat hand). This impact moves the mucus further up the airways. Once complete, you will be directed to cough powerfully enough to finish clearing the mucus from your lungs.
Important to note: To avoid injury or upset, the person clapping should never touch the spine, breastbone, stomach, lower ribs or back.
Percussion and postural drained should be done on an empty stomach, either before a meal or two and half hours after one.
Chest physiotherapy: Autogenic drainage (AD)
Autogenic drainage (AD) is an airway clearance technique that uses controlled breathing with escalating lung volumes to loosen and transport mucus up and out of the lungs.
This happens in three stages, working on build-up from the outside of the airways toward the middle and then to the central airways where it can be cleared. Stage one involves low volume breaths. Stage two is medium or tidal breaths. Stage three is large volume breaths that allow you to cough or hawk up the mucus. A chest physiotherapist can guide you through each stage, advising you on what you should be feeling and/or hearing and when you should start coughing.
Chest physiotherapy: Active cycle of breathing technique (ACBT)
Your physiotherapist can teach you proper active breathing techniques (ACBT) to help clear mucus from your lungs. They may start with breathing control (in and out through your mouth, if possible), following by deep breathing (sometimes holding the breath for two to three seconds before letting it go) and then huffing.
Huffing is a forceful exhalation through your throat, like you’re trying to fog up a mirror. Your stomach muscles pull in and your mouth should make a “haw” sound.
Chest physiotherapy: Positive expiratory pressure devices (PEP)
Positive expiratory pressure devices (PEP) like a mask or handheld mouthpiece assist with breathing techniques that can clear your lungs.
The PEP device allows you to breathe in freely but provides resistance when you breathe out. To push past this resistance, you need to exhale harder, about four times as long as your in-breath. This gets your mucus moving and keeps your airways open while doing so.
Chest physiotherapy: Oscillating PEP
Like in regular PEP, this device allows an easy breath in and resistance on the breath out. However, a PEP device also creates vibrations (or oscillations) on the out-breath to move mucus from the peripheral and middle airways up to the central airways. After several out-breaths, you will be instructed to cough or huff to fully clear the mucus from the lungs.
Both of these sessions with PEP devises (oscillating and non-oscillating) take about 20 minutes or 20 breaths, depending on the severity of the build-up.
