The role of chest physiotherapy in mucus hypersecretion

Review of the data shows that chest physiotherapy (CP) is effective in clearing secretions from the lungs of patients with copious secretions (i.e., daily sputum production in excess of 30 ml). Assessment of the various components of CP shows that percussion, vibratory shaking, and breathing exercises have little to offer. Although instructed cough, the back up mucus clearance mechanism, is effective in clearing secretions its effect is less than that achieved with the forced expiration technique (FET). Postural drainage (PD) is on the whole successful in helping to drain secretions in the lungs. The administration of a beta 2-agonist via a nebulizer prior to CP in addition to promoting bronchodilation may also help to alter the physical properties of secretions, rendering them more amenable for clearance by FET/cough. Technology regarding high-frequency oscillations (HFO) has yet to be improved and its efficacy in clearing excess secretions proven prior to its inclusion in a CP treatment regimen. Intermittent positive pressure breathing (IPPB) may have a role to play in those patients where conventional CP is not possible. Data with positive expiratory pressure (PEP) are encouraging and direct evaluation is awaited regarding its effect on mucus clearance. With our present knowledge it seems reasonable to recommend that physiotherapists concentrate their CP treatment on the following: administration of a nebulized beta 2-agonist followed by PD and FET.