Chest Physiotherapy (CPT)
CPT is a familiar treatment in diseases such as Cystic Fibrosis. Strictly speaking its used to mobilize secretions and promoting the removal of these secretions by an effective cough. Its made up of three components; Turning, Postural Drainage, and External Manipulation of the Thorax (percussion and/or vibration).
The AARC's Clinical Practice Guidelines for the use of CPT states that the indications for CPT are: (indications that are appropriate to asthma are highlighted)
A. Turning
| 1. |
Inability or reluctance of patient to change body position (e.g., mechanical ventilation, neuromuscular disease, drug-induced paralysis. |
| 2. |
Poor oxygenation associated with position (e.g., unilateral lung disease) |
| 3. |
Potential for or presence of atelectasis. |
| 4. |
Presence of artificial airway. |
B. Postural Drainage
| 1. |
Evidence or suggestion of difficulty with secretion clearance. |
| |
a. |
Difficulty clearing secretions with expectorated sputum production greater than 25-30 mL/day (adult). |
| |
b. |
Evidence or suggestion of retained secretions in the presence of an artificial airway. |
| 2. |
Presence of atelectasis caused by or suspected of being caused by mucus plugging. |
| 3. |
Diagnosis of diseases such as cystic fibrosis, bronchiectasis, or cavitating lung disease. |
| 4. |
Presence of foreign body in airway. |
C. External Manipulation of the Thorax
| 1. |
Sputum volume or consistency suggesting a need for additional manipulation (e.g., percussion and/or vibration) to assist movement of secretions by gravity, in a patient receiving postural drainage. |
NOTE: A relative contraindications for External Manipulation of the Thorax include bronchospasm, also included in the Hazards/Complications of CPT in bronchospasm. This basically means that in the presence of bronchospasm, percussion and vibration may need to be modified or stopped if bronchospasm is severe. Also, CPT can cause or exacerbate bronchospasm. In my opinion, this complication and relative contraindication are results of increased coughing associated with the movement of secretions.
CPT has very specific uses, and its appropriate use with asthmatics must meet at least one of the above criteria. If not, CPT is inappropriate and should not be ordered. The production of significant amounts of thick mucus and mucus plugging do occur in asthmatic and can be appropriately treated with CPT.
Performance of CPT by untrained and inexperience people can result in physical injury and/or exacerbation of asthma symptoms. CPT should only be done under order of a physician, and only by personnel that have been properly trained in performing this procedure.
Caregivers (family members, significant others, friends) should only perform this procedure after being trained and observed by a skilled health care professional such as a Respiratory Therapist, Physical Therapist, or Nurse (only if the nurse is proficient in this therapy). Respiratory Therapists are the best choice, since they have been extensively trained in CPT and perform this therapy as a routine part of their job.
Training in CPT should include positioning for Postural Drainage of the prescribed lung segments (there are 16 total), Clapping and Vibration technique for each segment, recognition of complications and patient distress, patient assessment (basic lung sounds, pulse, and respiration), and modifications to therapy in order to meet patient needs.
