Physiologic Effects of Chest Percussion and Postural Drainage in Patients with Stable Chronic Bronchitis" D. Barry May~ M.D.; and Peter W. Mum, M.D., F.C.C.P.
The etfects of a JO-minute period of chest peI'CII8SioII aDd postural drainage were compared to • sIIam treldmeDt (IDfrared lamp) in 35 patieo" with stable chronic bronchitis and to a period of directed co....... Ia 11 of these same patients. There were DO Menaces In subjective responses or arterial blood p i levels fo8owiDI tlaerapy. Spirometric studies showed smaD improvementl over baseUne values foDowinc either treatmeIIt but ao dUrer-
Chest percussion and postural drainage are widely used for varied respiratory ailments; however, clinical studies showing therapeutic ef6cacy are lacking. l .! Patients with chronic bronchitis have hyperplasia of the mucous glands and may produce sputum with altered rheologic properties and abnormal mucociliary clearance," Maneuvers to enhance the expectoration of sputum might well lessen the obstruction of airways, with concomitant improvement in ventilation and gas exchange. . In prospective studies of patients with exacerbations of chronic bronchitis, Anthonisen et aI" and Petersen et als found no differences in the rate of improvement in pulmonary functions, arterial blood gas levels, or clinical course between controls and those who received chest physiotherapy. This might have been due to the multiplicity of factors involved in the recovery from acute illness over many days and the increased variability in data when comparing two separate groups of patients. It seemed more likely to us that signiJicant alterations following physiotherapy could be detected by measuring shortterm changes, using a period of sham therapy, with the patient as his own control, and studying him in a relatively stable phase of his illness. We investigated a group of patients to determine if there are identifiable short-term alterations in ventilation and gas exchange following chest percussion and postural drainage. ·From the Deparbnent of Medicine, Queen"s University, Kingston. Ontario. Supported in part by a grant &om the Ontario Respiratory Diseases Founaation. Man~pt received January 20; revision a~ted June 23. Repnnt requests: Dr. Munt, Deptlffrnenf of JledIcfnB, QwenI UnitJemty~ Kingston~ Ont4rio~ CtmtJda K1L3N6.
CHEST, 75: 1, JANUARY, 1979
eoce between lldive _d ...... treatments. The volaDle
of sputum expectorated duriDa percaaioD and draIDage w. sipilamfty pater tbaD duriDa tile lafJaed warmlog (5.5 f t L4 mI) or d..... tile directed coaaJdaI (9.0 vs 3.5 mI). AIthougb chest percualoD _d postural dralnage an etfective In -ameli.... the volDJDe of upectorated sptdaJD, DO slpificant aIternatio_1a air low 01' PI exclum&e after two boon were demoDSCratecL
MATERIALS AND METHODS
Thirty-five patients (29 men and six women) with chronic bronchitis6 volunteered. The mean age was 59 years (range, 37 to 83 years). The median value for the forced expiratory volume in one second (FEV1) was 1.440 ml (range, 410 to 3,600 ml), the median arterial oxygen pressure (PaO z ) was 69 nun Hg (range. 50 to 88 mm Hg), and the median arterial carbon dioxide tension (PaCOz) was 36 mm Hg (range, 27 to 49 mm Hg). All 35 patients bad a history of chronic productive cough and obstructive disease of the airways on testing of pulmonary function. Several bad mixed disease, with components of emphysema or bronchiectasis. All but one patient had been cigarette smokers. The patients were studied while in the hospital for nonrespiratory reasons or just prior to discharge if admitted with an acute respiratory exacerbation. Patients who bad markedly reactive airways, who required therapy with supplemental oxygen, or who had fixed beliefs about chest physiotherapy were excluded. Each patient gave informed consent to the protocol approved by a university ethics committee. The patients were informed that we were comparing two forms of physiotherapy, ie, postural drainage with chest percussion to infrared warming of the chest. Every patient received both methods of treatment, one on each of two consecutive mornings in random sequence. Infrared heat was administered for ten minutes to the anterior surface of the chest with the patient lying on one side, followed by a ten-minute supine resting period and then ten minutes of heat to the back with the patient on the opposite side to achieve comfortable warming. Chest percussion was performed in the patient's bed for 90 seconds in each of seven drainage positions directed to the upper lobe posterior bronchi. middle lobe. lingula, and lower lobe basal segments with the bed raised 11 inches, a modification of methods described in the BromJ]fon HOSf)ital GuIde to Chest Phyriotherdpr/7 and Intemioe tJnd RehabiUIatioe Respiratof'rJ CQf'e.8 Several vibrations, assisted coughing, and a brief rest completed each sequence. Treabnents were given
PHYSIOLOGIC EFFECTS Of CHEST PERCUSSION AND POSTURAL DRAINAGE 29
Percussion and Drainage
Mean volume of sputum, ml·
·Mean ± BE. "P