Chest Postural Drainage
(2000) by: Howard M. Lederman, M.D., Ph.D., Professor of Pediatrics, Medicine and Pathology
Division of Pediatric Allergy and Immunology, Johns Hopkins Hospital
Postural drainage (chest physiotherapy) may be prescribed by your child’s physician to help clear secretions from the airways of the lungs. The following material on segmental bronchial drainage has been adapted from material by the Cystic Fibrosis Foundation, Bethesda, Maryland, and used with their permission.
What is Bronchial Drainage?
Bronchial drainage uses gravity and physical maneuvers to stimulate movement of secretions in order to relieve airway obstruction due to accumulated mucus or “phlegm.” This form of chest physical therapy can be prescribed for the prevention and/or treatment of some respiratory problems due to accumulated secretions.
Who can Benefit from Bronchial Drainage?
As a form of treatment, it helps individuals with respiratory problems caused by:
- increased production of secretions,
- thick or sticky secretions,
- impaired removal of secretions, and\
- ineffective cough,
- or combinations of any of these factors.
As a preventive measure, it benefits those persons with:
- predisposition for increased production or thickness of secretions and/or
- weakness of the breathing muscles.
What Physical Maneuvers Can Assist in the Removal of Secretions?
Chest physical therapy consists of maneuvers that help remove secretions from the walls of the airways and stimulate coughing. These maneuvers include: positioning to allow secretions to flow by gravity from individual segments of the lung into larger airways, clapping with the cupped hand, vibration, deep breathing and assisted coughing.
Clapping is done with the cupped hand on the chest wall over the segment to be drained. Clapping initiates vibrations which stimulate the movement of secretions and may help remove secretions sticking to the bronchial walls. The hand is cupped by holding the fingers together so that the shape of the cupped hand conforms with the chest wall and tends to trap a cushion of air which softens the blow of clapping. Clapping should be vigorous, but not painful, and should not be done on bare skin. The therapist should remove rings before clapping. Clapping is usually performed on the patient by the therapist or a person trained in the technique.
Vibration is also a maneuver which helps to stimulate the flow of secretions. This technique requires that the therapist’s hand be pressed firmly over the segment on the chest wall and the muscles of his upper arm and shoulder are tensed (isometric contractions). Vibration is done with the flattened, not the cupped hand. Vibration is performed during exhalation, with the patient saying “FFF” or “SSS.” Exhalation should be as slow and as complete as possible. Various mechanical vibrators are available commercially and may be helpful.
Deep breathing both assists in the movement of secretions and stimulates coughing. An effective cough is an essential part of clearing the airways. A forced but not strained exhalation, following a deep inhalation, may move secretions and may stimulate a productive cough. Coughing may be assisted by supporting the side of the lower chest with the hands, which decreases the strain of coughing and may increase its effectiveness.
To minimize the chance of vomiting, bronchial drainage is best done before meals or 1 1/2 to 2 hours after eating. Early morning and bedtime sessions are usually recommended. By helping clear the airways of accumulated secretions, bronchial drainage before bedtime may reduce nighttime coughing.
When used for treatment, bronchial drainage is usually recommended at lest twice daily. Additional bronchial drainage is often advised during acute respiratory infections and in instances where the extent of disease requires it. When drainage is used for prevention, it is usually recommended once or twice daily.