Physiotherapy management of patients with chronic obstructive airways disease

Various physiotherapy techniques have long been advocated as therapeutic tools for patients with chronic obstructive airways disease (COAD). The purpose of this review is to present an outline of the different techniques, a definition of the present controversies, and an illustration of the possible new directions for physiotherapy in the future. The following aspects of the disease are reviewed: pathophysiology; research; patient education; secretion removal (including techniques of coughing, postural drainage, and percussion); breathing control exercises (including use of the abdominal muscles, nasal inspiration, pursed lip breathing, positioning, alteration of regional ventilation, and the related short and long-term benefits); and thoracic mobility exercises. The authors conclude not only that the physical therapeutic techniques used with COAD patients are extremely diverse in nature, but that the investigations of their validity have been neither comprehensive nor conclusive. Immediate study is needed to define more specific physiological aims for each modality; more selective and effective treatment can then be performed and the true potential of chest physiotherapy realized.