Introduction
Chest physiotherapy is performed in patients with increased mucus retentions in certain conditions, such as cystic fibrosis, bronchiectasis, and chronic obstructive pulmonary diseases. Patients with lung congestion suffer from excessive breathing problems; therefore, physical therapists perform various manual techniques, such as percussion, shaking, postural drainage, active cycle of breathing techniques, and breathing exercises to loosen the mucus and to cough it out of the body. This article will detail the various therapeutic strategies of physiotherapy in treating patients with lung congestion.
What Happens in Patients With Lung Congestion?
The respiratory system in our body consists of a pair of lungs that are protected by the presence of a rib cage. The primary function of the lungs is to exchange gases. During inhalation, the lungs absorb oxygen from the air through diffusion. The structure called alveoli ensures the proper absorption of oxygen in the bloodstream. Vice versa, during exhalation, the carbon dioxide is passed through the bloodstream into the air through the lungs.
In patients with normal and healthy lungs, the oxygenated air moves freely through them with the help of hair-like structures called cilia. The mucus lining the lungs is normally watery and thin, playing a huge role in the body's defense mechanism. They entrap the unwanted irritants and expel them from the body. The mucus lining becomes thick with highly viscous in patients with lung congestion, such as cystic fibrosis and chronic obstructive pulmonary disease. This obstructs the airway by blocking the air ducts and passages, making breathing difficult. Increased lung congestion can also result in infections such as pneumonia.
What Is the Role of Physiotherapy in Treating Lung Congestion?
In normal and healthy people, the increased mucus secretion is expelled through the mucociliary clearance system and coughing. But it becomes difficult for patients with lung congestion to clear out the excess secretions, leading to various complications and extreme difficulty breathing. Increased secretion retention can interfere with the diffusion of oxygen and carbon dioxide. The physical therapist performs an individualized program of mucus secretion removal techniques in the involved area of the lungs, which can optimize the lungs' ventilation and gas exchange capabilities.
The mucus secretion removal technique may include dependent programs that rely on the caregiver, such as postural drainage, percussion, and shaking, or it may include independent programs, such as the active cycle of breathing technique (ABCT); positive expiratory pressure (PEP), such as TheraPEP® PEP Therapy system (Smiths, Medical, Dublin, OH), airway oscillation devices such as flutter® or the Acapella®; or high-frequency chest compression devices such as The Vest® system (Hill-Rom, St.Paul, MN).
What Are the Anatomical Considerations for Manual Secretion Removal Techniques?
Chest physiotherapy is performed based on the involvement of mucus secretion in a particular lung segment. Only with proper anatomical knowledge of the lungs can chest physiotherapy be performed successfully. The ultimate goal of chest physiotherapy is to loosen the mucus and move it to the larger airways so it can be coughed out and expelled from the lungs.
The pair of lungs are separated by the heart and various structures in the mediastinum. The right lung consists of three lobes (Upper, Middle, and Lower lobes), and the left lung consists of two lobes (Upper and Lower lobes). The upper lobes of both lungs consist of apical, posterior, and anterior segments and the upper lobe of the left lung contains the lingula, which corresponds to the middle lobe of the right lung. The lower lobe comprises the anterior, superior, basal, lateral, and posterior basal segments. Based on these anatomical considerations of the lungs, manual secretion removal techniques are performed using gravity by changing the patients in various positions.
What Are the Manual Secretion Techniques in Chest Physiotherapy?
The manual techniques involve the application of external forces over the chest wall, which facilitates airway clearance with the patient in a modified or gravity-assisted drainage position. This technique includes
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Postural drainage.
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Percussion techniques.
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Vibration or shaking.
What Is the Postural Drainage Technique?
Postural drainage, also called gravity-assisted drainage, involves positioning the patient so that the head is lower than the chest level. Positioning the patient so that the bronchus of the involved lung segment is at a right angle to the ground is necessary for postural drainage. Using gravity, these positions assist the mucociliary transport of excess mucus secretions in the lung.
For example, For theapical segment of the upper lobe, the position for the postural drainage involves
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The drainage table or the bed is flat.
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The patient leans back on the pillow at a 30-degree angle against the therapist.
For the posterior segment of the upper lobe,
