Is cough as effective as chest physiotherapy in the removal of excessive tracheobronchial secretions?

Abstract

The relative value of chest physiotherapy (including cough) and cough alone for the removal of excessive tracheobronchial secretions has been assessed in six patients with stable chronic obstructive lung disease. After labelling with inhaled radioactive tracer particles, clearance of secretions from selected central and peripheral lung regions was followed with a gamma camera linked to a computer. Cough alone and chest physiotherapy (including cough) were equally effective in the enhancement of central lung clearance. Physiotherapy but not cough alone accelerated peripheral lung clearance (p < 0 05). Sputum yield was greater during physiotherapy than during cough (p < 0-05). These findings confirm the value of chest physiotherapy and high-light the limitation of cough in patients with excessive tracheobronchial secretion and impaired mucociliary clearance.Since the description of simple manoeuvres in 1915,1 chest physiotherapy has become established in the treatment of chronic lung conditions associated with excessive tracheobronchial secretions. Objective evidence for its value, however, is both lacking and controversial.2 3 Using the radioaerosol tracer technique,4 we were able to establish the efficacy of the various combined manoeuvres of the chest physiotherapist with cough in aiding the removal of excessive secretions from central, intermediate and peripheral lung regions. Oldenburg et al,5 however, using similar techniques subsequently produced data suggesting that cough alone was as effective as chest physiotherapy combined with cough. We have therefore examined critically the relative roles of cough alone and chest physiotherapy with cough in enhancing regional lung clearance. MethodsSix patients (three men and three women) with stable chronic airway obstruction and regular daily expectoration took part in the study. Written informed consent from the patients and approval of the local ethics committee were obtained. Three patients had chronic obstructive bronchitis and three bronchiectasis. Three were non-smokers, two exsmokers, and one a current smoker. Their physical characteristics and ventilatory function are summarised in table 1.The labelling of tracheobronchial secretions by an aerosol containing uniform 5 ,um polystyrene particles firmly tagged with 99mTc (half-life 6 h) has been fully described previously.6 After the controlled inhalation of radioaerosol, the clearance of particles deposited throughout the tracheobronchial tree was monitored by external gamma counting using a Nuclear Enterprises Mark III gamma camera. Counts were collected from the anterior chest over five-minute periods at halfhourly intervals from 30 to 150 minutes after

Investigation of the Frequency and Force of Chest Vibration Performed by Physiotherapists

“…5 Both that study and ours showed the mean frequencies of vibration lower than those in other studies with recorded frequencies of 10 to 16 Hz. 6,7,9 The seven physiotherapists in our study who performed shaking instead of vibration (in at least one of the three conditions) applied frequencies outside those demonstrated in previous literature of 6.3 Hz 9 and 2 Hz 6,7 (see Table 1). Those studies evaluated vibration, shaking, or both techniques, performed on a black anaesthetic bag 6 or on intubated and ventilated sheep; 9 one study failed to indicate the method of measurement used.…”

“…6,7,9 The seven physiotherapists in our study who performed shaking instead of vibration (in at least one of the three conditions) applied frequencies outside those demonstrated in previous literature of 6.3 Hz 9 and 2 Hz 6,7 (see Table 1). Those studies evaluated vibration, shaking, or both techniques, performed on a black anaesthetic bag 6 or on intubated and ventilated sheep; 9 one study failed to indicate the method of measurement used. 7 It is not clear why these studies demonstrated differences in the frequencies of vibration or shaking.…”

“…Studies have reported the frequency for chest vibration and chest shaking to be 12-16 Hz 6,7 and 2-6 Hz, 6,7,9 respectively. Some claim that vibration is chest shaking (12-16 Hz).…”

“…Currently no study has evaluated the force and frequency of chest vibration when performed directly on the body or over a layer of sheet or towelling. [5][6][7] The primary aim of this study was to investigate the forces and frequencies of chest vibration produced on a human chest by physiotherapists working in a teaching hospital. The physiotherapists at this hospital had far less experience than those in the previous study.…”

Efficacy of Pursed Lips Breathing with Forced Expiration Techniques and Active Cycle of Breathing Technique on Pulmonary Mucus Clearance in Healthy Subjects

“…Regions of interest (ROI) were drawn by a radiologist to obtain counts in each lung region on each image. Division of the lung image into central, intermediate and peripheral zones was performed according to description of Bateman et al 16) The data from the right lung were analyzed. All counts were corrected for radionuclide decay and background radioactivity.…”