Chest physiotherapy: a review.

Postural drainage enhances mucociliary clearance and produces larger sputum volumes than an equivalent control period in disease characterised by excessive tracheobronchial secretions. Postural drainage, percussion and vibration will improve pulmonary function only in patients with large sputum volumes. There is no evidence that sputum yield is increased by the addition of percussion and vibration. From radioaerosol studies effective cough is limited to central airways. Breathing exercises may be of some immediate value in asthma but are without long term advantages and probably do not alter the ventilation of the underlying lung. IPPB probably does not improve delivery of bronchodilators and is of no benefit (and possible harmful) in the long term treatment of chronic bronchitis. Infective exacerbations of chronic bronchitis not characterised by copious volumes of sputum, uncomplicated pneumonia and routine post-operative states are not indications for chest physiotherapy. The value of regular physiotherapy on ventilation, gas exchange, work of breathing and incidence of infective exacerbations is uncertain but exercise training and rehabilitation of chronic obstructive airways disease improves exercise tolerance and mobility.