Chest Physical Therapy (CPT)

Chest physical therapy (CPT) is a treatment that helps to remove secretions from the lungs.  For some people, this treatment is only needed for a short time after having a lung illness.  Others with chronic lung disease will need to perform these treatments daily because they have a lot of mucus produced in their lungs.  CPT helps you move the mucus to the upper airways where it can be coughed out.  This reduces your chance of lung infections and makes breathing more comfortable.  CPT is made up of two things, postural drainage and percussion.

 

Postural Drainage

 

Postural drainage removes mucus from certain parts of your lungs by using gravity.  By placing yourself or your child in certain positions, mucus drains to bigger airways where it can be coughed out.  We figure out what positions you need to do based on what parts of your lungs collect mucus.  Your doctor will tell you which part of your lungs needs to be cleared.

 

Scheduling the Treatment

 

The treatment often works best in the morning.  This allows mucus to be removed that has built up during the night.  Sometimes a treatment can be done at night to reduce the need for coughing during sleep.  Make sure you wait at least 1-2 hours after eating before starting your treatment.  This helps to prevent nausea and/or vomiting.  Doing CPT just before meals may cause you to become tired and may decrease appetite.

 

Positioning

 

The pictures on pages 4 – 7 show the positions that drain certain parts of the lungs. Your doctor or a member of your health care team will show you the positions you should use.  If you will be draining the lower lung areas you need to tilt the chest area 10-20 degrees below the horizontal level. This is done by:

 

• Propping firm pillows under your hips, on the bed, floor or couch.

• Using a positional lounge chair.

• Placing couch cushions on the floor under your hips.

• Placing a large beanbag chair under the hips.

•  Propping a 2' x 6' board (such as an ironing board) against a couch.

 

Note:   If your child has Cystic Fibrosis and is under the age of 5, you will keep the chest horizontal, not tilting the area.   

You should remain in the position for at least 5 minutes or longer if you can.  If you find that you drain a large amount of mucus in certain positions, spend more time draining these areas.  If you find that one position hurts too much or makes you short of breath, tell your doctor. They can help you to find a position that will be less painful or that will make you less short of breath.

 

Deep Breathing and Coughing

 

Deep breaths are taken once in a while throughout the treatment.  This helps expand your lungs where mucus has collected and helps to remove the mucus.  Avoid taking too many deep breaths in a row.  This may cause you to feel dizzy or have a tingling feeling in your arms and legs.

 

Coughing is one of the main parts of CPT treatments.  It should be done after each drainage position.

 

For a good cough, you should sit up, take a deep breath, hold it for a second, and exhale with an open mouth.  Practice as though you’re trying to fog up a mirror.  Avoid coughing head down. If you feel you need to cough while head-down, sit up to cough before going on with the treatment.  A forced, long cough or many coughs on one breath are not effective and are very tiring.  Rest a few minutes after a hard coughing spell, so that you will feel at ease finishing the rest of the treatment.

 

Percussion

 

Percussion (CPT) may also be ordered with postural drainage to help remove the mucus.

 

Perform CPT by clapping with a cupped hand over the part of the lung that is being drained.  The cupped hand forces a cushion of air against the chest wall.  This vibrates the lungs, which loosens secretions.  Hold your hand as if you were going to drink water from it (see picture below).

 

 

 

Percussion should be done on the round areas shown on each postural drainage picture, and should always be done over the rib cage.  Never percuss over the spine, breasts, clavicles, or breast bone (sternum).  It should also be done over a thin article of clothing or a towel, never on bare skin.

 

Percussion should last 3-5 minutes per area that is being drained.  Areas that have a lot of mucus drainage may require more time.

 

If cupping is hard to do, soft plastic hand-held percussor cups or mechanical percussor may be used.  Check with your health care team if you wish to try these devices.

 

Vibration

 

Vibration is a technique that also helps the movement of mucus during postural drainage and percussion.  Someone will have to do the vibration on you.  He will need to tense his arm and shoulders and rapidly shake your chest wall while you exhale.  A flattened hand should be kept over the area that was percussed.  Vibration can be done for 3-4 deep breaths.  This should be followed by coughing.  Vibration should be done gently to avoid rib injury.

 

Chest Physical Therapy Positions for Infants and Children

 

Below are the drainage positions for CPT.  The white ovals show you where to percuss.  During therapy it is useful to have tissue or a basin handy to collect mucus.  A glass of water may also be helpful for those who can cough better after their throat is wet.

 

Upper Lobes

 

Lean forward 30°.  Percuss between the clavicle and the shoulder blade on each side of the chest.

 

 

Lean back 30°.  Percuss between the clavicle and the nipple on each side of the chest.

 

 

Lower Lobes

 

The body should be positioned with the child’s head down 30°and lying on the right side.  Percuss on the left side below the underarm.  Note: If your child has Cystic Fibrosis and is under the age of 5, you will not be tilting the chest area, but will keep the chest horizontal.

 

 

The body should be positioned with the child’s head down 30°and lying on the left side.  Percuss on the right side below the underarm.  Note:If your child has Cystic Fibrosis and is under the age of 5, you will not be tilting the chest area, but will keep the chest horizontal.

 

 

           Horizontal                                 Head down 30º

 

 

The body should be positioned with the child’s head down 30°and lying on the abdomen.  Percuss between the lower edges of the rib cage and behind the underarm on each side of the spinal cord.  Note: If your child has Cystic Fibrosis and is under the age of 5, you will not be tilting the chest area, but will keep the chest horizontal.

 

 

The body should be positioned with the child’s head down 30°and lying on the back.  Percuss on the front of the chest in the nipple area and just below.  Note: If your child has Cystic Fibrosis and is under the age of 5, you will not be tilting the chest area, but will keep the chest horizontal.

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The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Any duplication or distribution of the information contained herein is strictly prohibited.

Last Updated: 06/13/2007

Pictures of infant and child CPT with permission of Levy, Janine, The Baby Exercise Book, Random House, Inc., 1973.

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