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PubMedDate not supplied

Alternatives to percussion and postural drainage. A review of mucus clearance therapies: percussion and postural drainage, autogenic drainage, positive expiratory pressure, flutter valve, intrapulmonary percussive ventilation, and high-frequency chest compression with the ThAIRapy Vest.

The purpose of this article is to review published studies on the efficacy of old and new mucus clearance techniques and to develop recommendations for different groups of patients. Mucus clearance is a problem in cystic fibrosis, bronchiectasis, and many other pulmonary conditions. Percussion and postural drainage (P & PD) was the traditional method of facilitating mucus clearance, but the many hazards and contraindications along with the onerous nature and resultant poor patient compliance of this procedure have led to the development of alternative therapies. Research studies with cystic fibrosis patients support the efficacy of P & PD in patients who can tolerate it. However, equivalent sputum production can be accomplished with autogenic drainage, positive expiratory pressure, and Flutter valve therapy without the assistance of another caregiver, as long as the patient has the motivation, breath control, and neuromuscular function to perform these modalities. The Intrapulmonary Percussive Ventilation device and high-frequency chest compression with the ThAIRapy vest involve more elaborate and expensive equipment, yet these devices provide mucus clearance assistance to patients who lack the ability to perform the simpler techniques. Both mechanized modalities promote independence and self-care in the patient, and the effectiveness of both has been supported by the limited research published to date. Which alternative to recommend depends on the ability, motivation, preference, needs, and resources of each patient.

Cystic Fibrosis↗

PubMed2002

Positioning versus postural drainage.

For the past 70 years positioning and postural drainage have played an important role in increasing lung volumes, perfusion, oxygenation and mobilization of secretions. While gravity is not a primary mechanism for normal secretion clearance, it plays a major role in depth and pattern of ventilation, perfusion, and lymphatic drainage. Changing patient position, or turning patients on a regular basis, is a powerful tool in maintaining lung health in a broad range of patients. In contrast, postural drainage requires considerable investment of time, and has been shown to have limited benefit in most patients. Postural drainage has been shown to improve mobilization of secretions in patients with cystic fibrosis as well as patients who produce, and have difficulty clearing, large quantities of sputum. The benefits of postural drainage appear technique-dependent, requiring sufficient drainage time (3 - 15 min) for each position drained. The evidence does not support the use of vibration and percussion independent of active postural drainage. Exercise offers benefit in secretion clearance, which increases when combined with a program of postural drainage. In conclusion, routine turning, mobilization and exercise is important to maintain lung health in all patients, while postural drainage, properly applied, has been shown to improve secretion clearance in a relatively narrow range of patients with cystic fibrosis and excessive sputum production.

Contraindications↗

PubMed1986

Practice, problems and compliance with postural drainage: a survey of chronic sputum producers.

Fifty outpatients with chronic respiratory disease, who had previously been requested to perform regular postural drainage, were asked to complete a questionnaire designed to assess their usual practice of postural drainage, their impression of its value and their problems and compliance with it. The group performed a median of one session of postural drainage lasting 15 minutes daily, increasing to two sessions lasting nearly 40 minutes daily during exacerbations of chest symptoms. Seventeen patients had difficulty finding time for postural drainage, 15 found it distasteful and in 17 postural drainage caused discomfort or pain. Twenty-seven patients were judged to be performing inadequate postural drainage, despite individual initial instruction and regular follow-up in a respiratory outpatient clinic. Other diverse reasons for poor compliance revealed by the survey are discussed and recommendations made to encourage improved compliance.

Adolescent↗

PubMed1996

[Pulmonary abscess treated with postural drainage].

Case record of patients with lung abscess treated by postural drainage is presented in this paper. In young man with multiple explosive injuries lung abscess was formed two months after injury. A postural drainage with parenteral application of antibiotics has been performed. The expectoration was painful. At the seventh day there was no temperature, ESR was described at the tenth day. The general status was becoming better. At the seventeenth day patient was discharged from Hospital. Rig imaging was shown nearly completely resolution of lung abscess. Postural drainage was effective because of favorable localisation of abscess near the large bronchus and basely part of the lung.

Adult↗

PubMed1995

Chest physiotherapy in cystic fibrosis: a comparative study of autogenic drainage and the active cycle of breathing techniques with postural drainage.

BACKGROUND--Autogenic drainage has been suggested as an alternative method of chest physiotherapy in patients with cystic fibrosis. In this study autogenic drainage was compared with the active cycle of breathing techniques (ACBT) together with postural drainage. METHODS--Eighteen patients with cystic fibrosis took part in a randomised two-day crossover trial. There were two sessions of one method of physiotherapy on each day, either autogenic drainage or ACBT. The study days were one week apart. On each day the patients were monitored for six hours. Mucus movement was quantified by a radioaerosol technique. Airway clearance was studied qualitatively using xenon-133 scintigraphic studies at the start and end of each day. Expectorated sputum was collected during and for one hour after each session of physiotherapy. Pulmonary functions tests were performed before and after each session. Oxygen saturation (SaO2) and heart rate were measured before, during, and after each session. RESULTS--Autogenic drainage cleared mucus from the lungs faster than ACBT over the whole day. Both methods improved ventilation, as assessed by the xenon-133 ventilation studies. No overall differences were found in the pulmonary function test results, but more patients had an improved forced expiratory flow from 25% to 75% with autogenic drainage, while more showed an improved forced vital capacity with ACBT. No differences were found in sputum weight and heart rate, nor in mean SaO2 over the series, but four patients desaturated during ACBT. CONCLUSIONS--Autogenic drainage was found to be as good as ACBT at clearing mucus in patients with cystic fibrosis and is therefore an effective method of home physiotherapy. Patients with cystic fibrosis should be assessed as to which method suits them best.

Adolescent↗

PubMed1976

Management of tracheobronchial foreign bodies in children: a reevaluation of postural drainage and bronchoscopy.

The efficacy of the inhalation-postural drainage technique for removal of aspirated foreign bodies was compared with that of bronchoscopy in 76 children. Twelve of 49 children on postural drainage coughed out the foreign body (25%); the other 37 required bronchoscopy. The foreign body was successfully removed in 56 of 63 children who were bronchoscoped (89%). Our experience suggests that a trial of inhalation-postural drainage, administered in a hospital, may be valuable in the initial management of aspirated foreign bodies. If unsuccessful after several treatments, however, the technique should be abandoned, and bronchoscopy performed. Delay of foreign body removal beyond 24 hours may be associated with increased morbidity and prolonged hospital stay. With recent improvements in pediatric endoscopic instruments, the efficacy of bronchoscopy exceeds 90%.

Bronchi↗

PubMed1986

The value of the forced expiration technique with and without postural drainage in adults with cystic fibrosis.

The effect of the Forced Expiration Technique (FET) with or without Postural Drainage (PD) was examined in eight adults with cystic fibrosis. On four mornings the patients followed a 30-min physiotherapy session consisting in a randomized order of either FET in a sitting position following a night of horizontal sleep ("FET"), or FET in a postural drainage position following sleep including postural drainage ("FET/PD"). The lung function parameters studied did not change during either of the two treatments. Sputum yield over 22.5 h before the physiotherapy sessions and over 24 h increased with PD during sleep in patients with more than 30 g of sputum per 24 h (p less than 0.05). PD during the treatment sessions did not further increase sputum production. This study indicates that sleeping head-down improves expectoration in patients with copious sputum. PD during FET is not needed after sleeping in the head-down position.

Adolescent↗

PubMed1997

[Study of postural drainage of children with obstructive lung disease].

According to the abnormal manifestation of the X-ray chest film, 90 cases were classified into regional shadow and diffuse volume increasing parts. The regional postural drainage method was adopted in the former, all directional postural drainage was performed in the latter. Each part of cases was classified into postural drainage plus ultrasonic aerosol inhalation group, ultrasonic aerosol inhalation and the control group. The results showed that there were significant differences among the parameters of the body temperature, coughing, stridor, rales and the chest film (P < 0.01). The therapeutic effects of the inhalation group was predominantly better than that of the control group with the routine drug treatment, while that of the drainage was more better than that of the inhalation group. It is suggested that the drainage as an adjuvant treatment to treat the obstructive respiratory tract diseases was a cheap, practical, non-damage and worthy advocating method.

Aerosols↗

PubMed1979

Maximal expiratory flows after postural drainage.

Flows measured from maximal expiratory flow-volume (MEFV) curves were used to evaluate the efficacy of postural drainage in improving ventilatory function acutely. Maximal expiratory flow-volume curves were obtained for 9 cystic fibrosis subjects and 10 subjects with chronic bronchitis before and 5, 15, and 45 min after a 30-min session of postural drainage with percussion, vibration, and coughing. Forced vital capacity (FVC) was significantly increased 45 min after drainage for the combining group. Flows at high lung volumes were different for the 2 subgroups. Subjects with cystic fibrosis demonstrated a significant increase in peak expiratory flow rates 45 min after drainage and an increase in forced expiratory volume in one sec at all time intervals. The subjects with chronic bronchitis had a decreased peak expiratory flow rate 5 min after drainage, but by 45 min, it had returned to baseline. There was no significant change in one-sec forced expiratory volume at any time interval for the chronic bronchitis subgroup. Changes in flows at low lung volumes were similar for the 2 subgroups. Forty-five min after drainage there was an increase in flow rates near 50 per cent of FVC. Flows near 25 per cent of FVC were increased 15 and 45 min after drainage. This study demonstrated that postural drainage with coughing resulted in significant improvement in flows at low lung volumes. Changes in flows at high lung volumes were less consistent.

Adolescent↗

PubMed1987

Comparison of a positive expiratory pressure (PEP) mask with postural drainage in patients with cystic fibrosis.

The use of a positive expiratory pressure (PEP) mask was compared with postural drainage in the treatment of 10 patients with cystic fibrosis. The patients were allocated randomly in a crossover fashion to the two regimens and evaluated initially by a physiotherapist and over a 4 week treatment period by use of a diary card. There was no significant difference in sputum production or change in lung function between each technique as assessed by the physiotherapist. Diary card evaluation also failed to demonstrate a difference in sputum production, symptom score or peak expiratory flow rate between the 4 week treatment periods. It was concluded that PEP mask therapy is an acceptable and effective alternative to postural drainage in interval therapy of patients with cystic fibrosis, although the patients have tended to revert to postural drainage during acute exacerbations.

Adolescent↗

PubMed1997