Chest physical therapy is often used with bronchodilators and inhaled antibiotics. Bronchodilators are taken before chest physical therapy to open the airways and inhaled antibiotics are taken after (PD&P) to treat the open airways.
The affected person is placed in one of many bronchial drainage positions. Percussion, also known as clapping, is performed from one to five minutes. Percussion is done by forming a cupped hand and hitting the chest wall. The cupped hand allows air to be trapped, which softens the clapping. Percussion is not painful, in fact it can be very relaxing for children and adults with CF. Percussion should be done over the ribs only. Percussion should not be done over the spine, breastbone, stomach, lower back and lower back ribs. Percussion should never be done directly on the skin.
Vibration is usually performed following percussion over the same lung segment. Vibration is usually done for 15 seconds. Vibration gently shakes the mucus into larger airways, so that it can be coughed up easier. Vibration is done by using a flat hand and gently vibrating the area while the affected person performs deep breathing. Deep breathing helps to loosen mucus and stimulate coughing. The affected person then coughs to try to remove the thickened mucus from the lungs.
There are some bronchial drainage positions that may cause some individuals to vomit or experience severe heartburn, especially when their heads are lower than their stomachs. Some of these individuals may be experiencing reflux; reflux can lead to lung infections, and lung damage. If this happens during percussion, notify your health-care professional. There are other positions or airway clearance techniques that may work better.
Percussion and vibration techniques may be slightly different for each patient. The cystic fibrosis accredited care center will educate and instruct each family on percussion and vibration. They will set up a plan for postural and drainage techniques that are specific for each individual person.
- Postural drainage and percussion can be done by family, friends and health-care professionals. However, it should only be performed by people who have been instructed in proper chest physical therapy techniques. Family and friends can be instructed to perform postural drainage by a licensed respiratory therapist, pt or a physician.