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 need to perform these treatments daily. CPT consists of two different therapies called postural drainage and percussion.
Postural drainage removes mucus from certain parts of your lungs by using gravity. By placing yourself or your child in different positions, mucus drains to the bigger airways where it can be coughed out.
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 your appetite.
The pictures on pages 4 – 7 show the positions that drain certain parts of the lungs 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.
Deep Breathing and Coughing
You should remain in each position for at least 5 minutes or longer if possible. If you find that you cough up large amounts of mucus when you use 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 find a position that will be more comfortable.
Deep Breathing and Coughing
Deep breaths should be taken once in a while throughout the treatment. This helps you expand your lungs and strengthens your cough. It should be done after each 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 with your head down. 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 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 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 is a technique that also helps the movement of mucus. You will need someone to help you. Have your helper place their flattened hand over the area that was percussed. When you take a breath in and exhale, the helper should rapidly but gently shake your chest while you exhale. Repeat this procedure three times after percussing each position. Follow all vibration therapies with a cough.
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.
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.
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 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.
Pictures of infant and child CPT with permission of
Levy, Janine, The Baby Exercise Book, Random House, Inc., 1973.
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: 02/27/2013
Copyright © 02/27/2013 University of Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#4916
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