Cystic Fibrosis (CF) Treatment: Manual Chest Physiotherapy

Manual chest physical therapy (CPT) is the traditional airway clearance technique for cystic fibrosis patients. The removal of obstructive, thick sticky secretions is important in preventing infections and helps ease breathing. Manual chest physiotherapy consists of two parts:

1. Postural drainage
2. Percussion and vibration.

Postural Drainage

Postural drainage pertains to placing the body in a position which allows the mucus to drain from the smaller airways into the main airway with gravity. Two positions are in an upright sitting position and four positions are with the head tilted below the lungs. To obtain the head-down positions, the use of a pillow, a bean bag chair or couch cushions works well.

Percussion and Vibration

Percussion and vibration help loosen and mobilize secretions. Percussion is a repetitive tapping on the designated position and can be done with palm cups (of varying sizes), by hand or with a manual percussor.

If you choose to use your hands, the palm of your hand should be cupped to provide a pocket of air that cushions the percussion. Manual percussors have padding and velcro to allow self-use. Vibration is done at the end of the position. After a big breath in, vibrate when the air is slowly blown out, for three big breaths.

Six Manual Chest Physiotherapy Positions

• Each position requires proper placement for percussion and should be done for three to five minutes
• Nothing should be placed in the mouth (pacifiers, food, etc.) while doing manual chest physiotherapy
• A strong cough is encouraged after each position to remove the mucus
• It is recommended that manual chest physiotherapy be done before meals and bedtime. Your doctor will determine how often manual chest physiotherapy is neede
• Airway clearance is a very important part of the daily cares in cystic fibrosis, and we recommend this a minimum of once per day for all patients (even those without a cough)
• As infants grow it may become more challenging for them to cooperate with manual chest physiotherapy. You may find that it helps to make therapy time a special time. This can be done with a toy, watching a video, or a sticker reward. Keep these times special by only giving them with cooperation of therapy and not allowing them to be used any other time.