Chest Percussion and Postural Drainage in Patients with Bronchiectasis

doi:10.1378/chest.88.3.360

Chest

Volume 88, Issue 3, September 1985, Pages 360-363

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Patients with chronic obstructive pulmonary disease have been treated routinely with chest physical therapy for many years in spite of a lack of scientific validation of this procedure. Only recently have the indications for chest physical therapy been clarified. It is currently believed that such therapy is especially beneficial in patients with copious secretions, and that it is less effective in patients with scanty secretions. No study has specifically evaluated the efficacy of chest physical therapy in patients with bronchiectasis. We accordingly evaluated 13 patients with stable bronchiectasis to determine the effects of chest physical therapy on pulmonary function, arterial oxygenation, and sputum production and to assess whether this therapy was associated with any significant side-effects. We found that chest physical therapy was safe and well tolerated and assisted the patients in mobilization of their sputum. However, such therapy had no immediate delayed effects on pulmonary function or oxygen saturation.

Section snippets

Methods

A total of 13 patients (11 men and two women), ranging in age from 31 to 68 (mean 52) years, were included in this study. The patients were selected from individuals seen in outpatient pulmonary clinics of the University Health Center Hospitals.

Patients were entered in the study if they met the following criteria:

(1)
Were diagnosed as having bronchiectasis and were being followed as outpatients by the University of Pittsburgh Division of Pulmonary Medicine. The diagnoses were, in general,

Results

Results of baseline pulmonary function tests and resting oxygen saturations for the study population are shown in Table 1. The patients had a wide range of pulmonary function abnormalities with reductions in forced vital capacity (mean 3.00 ±1.20 L – 69 ± 29 percent of predicted), FEV₁ (mean 1.66 ±0.74 L – 53±24 percent of predicted), and PEF (mean 5.05 ±3.00 L/s – 36 percent of predicted).

The results of pulmonary function testing, oxygen saturation measurements, and heart rate measurements for

Discussion

This study demonstrates that chest physical therapy in patients with bronchiectasis is safe and helpful in the mobilization of secretions. However, this removal of secretions is not associated with any change in the pulmonary function indices which were measured.

The results of chest physical therapy on pulmonary function in this study are comparable to that found in other studies of adult patients with stable chronic lung disease. Both May and Munt¹¹ and March¹² studied patients with chronic

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Cited by (51)

Nonpharmacologic airway clearance techniques – Is there trustworthy evidence for their clinical usefulness?
2017, Respiratory Investigation
Randomized clinical trial of mucociliary clearance techniques in non-cystic fibrosis bronchiectasis in children
2013, Fisioterapia
Evaluar la eficacia de las presiones manuales espiratorias lentas y aumentos de flujo espiratorio (AFE) combinadas con insuflación-exuflación mecánica (I-E M) y tos asistida (TA), frente al ciclo activo de técnicas respiratorias (CATR) en bronquiectasia infantil estable sin fibrosis quística (FQ).
Ensayo clínico aleatorizado en 2 grupos de 6 niños (edad 8,1 ± 1,3) que reciben 2 sesiones de fisioterapia respiratoria (FR) al mes. Las principales variables de estudio son: peso de esputo recogido tras sesión de FR y medición de la función pulmonar al inicio del estudio y a los 12 meses; capacidad vital forzada (CVF), volumen espiratorio máximo en 1 s (VEMS o FEV₁) y el flujo espiratorio forzado entre el 25%-75% de la CVF (FEF_25-75%). Asimismo, evaluamos el número de ingresos y exacerbaciones infecciosas y el impacto de la tos en la calidad de vida con el Leicester Cough Questionnaire (LCQ), al inicio y al final del estudio.
El peso del esputo y el FEF_25-75%, aumenta significativamente con las presiones manuales espiratorias lentas, AFE combinados con I-E M y TA, frente al CATR, en nuestra muestra. No hay diferencias significativas en cuanto a FEV₁ y CVF. El número de exacerbaciones disminuyó en ambos grupos con respecto al año anterior (sin tratamiento de FR), y la puntuación total del LCQ.
Las presiones manuales espiratorias lentas, AFE combinados con I-E M y TA, para la permeabilización de la vía aérea en niños con bronquiectasias sin FQ, producen beneficios significativos en comparación al CATR.
To evaluate effectiveness of manual expiratory pressure and expiratory flow increase (EFI) combined with mechanical insufflation-exsufflation (MI-E) and assisted coughing (AC) versus active cycle of breathing techniques (ACBT) in stable bronchiectasis children without cystic fibrosis (CF).
Randomized clinical trial with 2 groups of 6 children (age 8.1 ± 1.3) who received of respiratory physiotherapy (RP) sessions twice a month. The main endpoints studied are: weight of sputum collected after each session of RP and lung function measurements at baseline and 12 months, forced vital capacity (FVC), forced expiratory volume in 1 second (FEV₁), peak expiratory flow between 25%-75% of FVC (FEF_25-75%). We also evaluated the number of visits to emergency department, infective exacerbations and the impact of cough on quality of life with the Leicester Cough Questionnaire (LCQ), at the beginning and the end of study.
The weight of sputum and FEF_25-75% increase significantly with manual expiratory pressure, EFI combined with MI-E and AC versus ACBT in our sample. There are no significant differences in FEV₁ and FVC. Number of exacerbations decreased in both groups compared to the previous year (without CP treatment), and total score of the LCQ.
Slow manual expiratory pressure, EFI combined with MI-E and AC for airway permeabilization in children with non-CF bronchiectasis produce significant benefits compared to ACBT.
Chest Physiotherapy Techniques in Bronchiectasis
2012, Clinics in Chest Medicine
Citation Excerpt :
There is little evidence of the effectiveness of MTs. Evidence suggests a trend toward an increased rate of clearance with percussion and chest compression.21–23 PEP uses a set resistance that is applied throughout expiration to enhance the mobilization of secretions.
Impact of expiratory muscle strength training on voluntary cough and swallow function in Parkinson disease
2009, Chest
Cough provides high expiratory airflows to aerosolize and remove material that cannot be adequately removed by ciliary action. Cough is particularly important for clearing foreign particles from the airway in those with dysphagia who may be at risk for penetration/aspiration (P/A). Expiratory muscle strength training (EMST) was tested to improve cough and swallow function.
Ten male participants, diagnosed with Parkinson disease (PD), with videofluorographic evidence of penetration or with evidence for aspiration of material during swallow of a thin 30-mL bolus, completed 4 weeks of an EMST program to test the hypothesis that EMST would improve cough and/or swallow function. Measured parameters from an airflow waveform produced during voluntary cough, pre-EMST and post-EMST, included inspiration phase duration, compression phase duration (CPD), expiratory phase peak flow (EPPF), expiratory phase rise time (EPRT), and cough volume acceleration (VA) [ie, the EPPF/EPRT ratio]. The swallow outcome measure was the degree of P/A during the swallow task.
There was a significant decrease in the duration of the CPD and EPRT; the decrease in EPRT resulted in a significant increase in cough VA. Significant decreases in the P/A scores were found posttraining.
The results demonstrate that EMST is a viable treatment modality for a population of participants with PD at risk of aspiration.
Improvement in health status following bronchopulmonary hygiene physical therapy in patients with bronchiectasis
2008, Respiratory Medicine
Citation Excerpt :
Despite its routine use in both acute exacerbations and chronic non-cystic fibrosis (CF) bronchiectasis, the evidence for its efficacy is limited. BHPT may reduce sputum volume and increase clearance but there are no studies investigating the impact of BHPT on health-related QOL.6–8 A recent Cochrane database systematic review identified few clinical trials investigating BHPT in non-CF bronchiectasis and most of these contained small numbers of patients.9
Chronic productive cough is a common symptom in patients with bronchiectasis that is associated with a reduction in health-related quality of life (QOL). Bronchopulmonary hygiene physical therapy (BHPT) is widely prescribed for patients with bronchiectasis, although the evidence for its efficacy is limited. We set out to prospectively evaluate the impact of BHPT on health-related QOL in patients with non-cystic fibrosis bronchiectasis.
We assessed cough symptoms (0–100 mm visual analogue scale; VAS) and cough-related QOL in 53 patients with stable non-cystic fibrosis bronchiectasis at baseline and >4 weeks after outpatient-based BHPT. Cough specific health status was assessed with the Leicester Cough Questionnaire (LCQ; total score range 3–21, higher scores representing better QOL).
All patients with bronchiectasis complained of cough as the major symptom and had mean (SEM) FEV₁ of 2.1 (0.1) L. Cough-related health status was reduced at baseline; mean (SEM) LCQ score 14.3 (0.6). There were significant improvements in cough symptoms (mean cough VAS before 43.3 (3.6) vs after 27.5 (3.1); mean difference 15.8; 95% CI of difference 9.6–22; p < 0.0001) and cough-related health status after BHPT (mean LCQ total score before 14.2 vs after 17.3; mean difference 3.1; 95% confidence interval of difference 2.4–3.9; p < 0.001). A significant improvement was seen in all LCQ health-related domains (physical, psychological and social; all p < 0.001).
Our findings suggest that bronchopulmonary hygiene physical therapy can lead to a significant improvement in cough-related quality of life.
Effectiveness of erdosteine in elderly patients with bronchiectasis and hypersecretion: A 15-day, prospective, parallel, open-label, pilot study
2007, Clinical Therapeutics
Background: Mucus plugging and hypersecretion have been associated with an increased relative risk of death in patients with bronchiectasis who may or may not have chronic obstructive pulmonary disease (COPD), which is of prognostic relevance in the elderly. However, chest physiotherapy and/or the use of mucoactive agents is considered to be an effective therapeutic model in treating patients with COPD and bronchiectasis.
Objective: The objective of this study was to test the effectiveness of oral erdosteine in treating elderly patients with bronchiectasis and chronic mucus hypersecretion who have been referred to a pulmonary rehabilitation program.
Methods: In this 15-day, prospective, parallel, open label, pilot study, elderly patients with bronchiectasis, hypersecretion, a noncurrent smoking status, who had been consecutively enrolled at Ospedale Villa Pineta's Pulmonary Rehabilitation Center, Pavullo-Modena, Italy, were randomized into 2 treatment groups. Group 1 consisted of those patients receiving PO erdosteine 225 mg BID and chest physiotherapy; group 2 comprised those patients receiving chest physiotherapy alone. Forced lung volumes, arterial blood gases, respiratory muscle strength, walking capacity (as measured by 6-minute walking test [6MWT]), and visual analog scale (VAS) symptoms (cough and dyspnea) were recorded at enrollment and at the conclusion of the study. Mucus density (MD), mucus purulence (MP), and mucus volume produced (MVP) were assessed using a 3-point scale (0 = best or low; 1 = moderate; and 2 = worst or high) at baseline and at 5-day time points during the study period. All measurements were assessed by personnel blinded and not directly associated with the study administration.
Results: Thirty patients (21 [70%] male and 9 [30%] female; mean [SD] age, 71 [11] years; and mean [SD] weight, 66 [3] kg) were enrolled. Characteristics were similar in the 2 groups at baseline. At day 15, significant improvements were observed in 6MWT, VAS cough, and VAS dyspnea (P < 0.01) in both groups. However, a significant improvement in forced expiratory volume in 1 second and forced vital capacity (in milliliters) was observed only in group i (0.2 [0.3]; P < 0.05). At day 15, improvement was observed in mean (SD) in MD, MP, and MVP scores for both groups. Significant changes, however, were observed in all 3 measurements in group 1 (-0.80 [0.22], -0.71 [0.51], and 1.01 [0.39], respectively), whereas a significant improvement was observed only in MD (-0.55 [0.44]) and MVP (0.45 [0.62]) in group 2. The improvement in MVP observed in group 1 was significantly better than that observed in group 2 (P < 0.05).
Conclusion: This pilot study found that a regimen of PO erdosteine 225 mg BID in addition to routine chest physiotherapy provided some physiologic and clinical benefits in the treatment of these elderly patients with bronchiectasis and chronic mucus hyper-secretion.

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: Manuscript received January 22; revision accepted March 20.

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Chest

Clinical InvestigationsChest Percussion and Postural Drainage in Patients with Bronchiectasis

Section snippets

Methods

Results

Discussion

Lancet

Lancet

Chest

Chest

Effects of sputum on pulmonary function

Br Med J

Is cough as effective as chest physiotherapy in the removal of excessive tracheobronchial secretions?

Thorax

Assessment of forced expiration technique, postural drainage and directed coughing in chest physiotherapy

Eur J Respir Dis

The value of lung physiotherapy in the treatment of acute exacerbations in chronic bronchitis

Acta Med Scand

The effect of chest physiotherapy upon the FEV1 in chronic bronchitis

Med J Aust

Clinical Investigations
Chest Percussion and Postural Drainage in Patients with Bronchiectasis

The effect of chest physiotherapy upon the FEV₁ in chronic bronchitis