Attention
- Do not do chest physiotherapy if person
- Very unwell
- In early stages of chest infection/pneumonia — fever, fast breathing/RR, chest pain,
coughing up blood
- Having an asthma attack
- Start physiotherapy when fever gone or only mild, cough loose, RR in normal range
or only slightly raised
Infants and young children with chronic lung disease or chest infection
Attention
Do not use head-down positions. Keep infants and young children flat or upright
What you do
- Sit or lie child on your lap or comfortable flat surface
- Use chest percussion (clapping) — slightly cupped hand should make hollow (drum-like)
sound, not slapping
- With child leaning forward on lap or over shoulder, percuss back of chest wall near
shoulder, both sides — Figure 9.9
- With child lying back against adult's chest, percuss front of chest wall near shoulder,
both sides — Figure 9.10
- With child lying on each side, percuss near armpit — Figure 9.11
- With child lying on tummy, percuss near spine just under shoulder blade, both sides
— Figure 9.12
- AND/OR vibration — gently squeeze and shake chest wall as child breathes out. Use same positions
as percussion. Good if child coughs
- Try physical activities to improve airflow
- Tickling, giggling, laughing
- Jumping, short bursts of 20 star jumps, skipping for older children
Doing bubble PEP
- Bubble PEP aims to help
- Move sputum from smaller to larger airways so it can be coughed up
- Increase gas volume in alveoli (air sacs) that are underinflated due to sputum blocking
airways
Attention
- Change water every time
- Wash tubing and bottle in warm soapy water, dry thoroughly after use. Use a clean
dry bottle and tube each day
- Children may get dizzy if they take big breaths in and blow all way out with every
breath. Just slightly bigger breaths than normal are best
What you need
- 2 tall 2L plastic bottles with or without a handle (eg milk bottle)
- 1 for child, 1 for you to demonstrate with
- 2 pieces of thin walled tubing (eg suction tubing or garden drip line)
- 50cm long x 1cm wide, with internal diameter more than 8mm
- Tape to hold tubing in place, if needed
- 2 bowls to sit bottles in, to catch any overflow
- Food colouring, detergent
What you do
- Put 10–15cm of water in bottle. Check amount with physio
- Thread tubing down through handle to base of bottle — Figure 9.13, or tape tubing in place
- Put bottle in bowl, leave top of bottle open
- Blow through tube to make bubbles — Figure 9.14. Add food colouring and detergent to make it fun
- If too hard for child — tip out 2–3cm of water
Note: If child quite young — start with water only in case they suck by mistake.
Series of breaths is best, not just single breaths
- Aim to build up to at least 8–12 bubble breaths in a row, or 1–2 minutes of bubble
PEP breaths at a time
- After each set of breaths, let child have a break for a minute or so, then repeat
bubble breaths
- Do bubbling for about 10 minutes, depending on child’s age, respiratory condition
Now encourage variations
- Hum a tune. Each line = 1 full breath
- Blow your longest breath out at end of a set of breaths
- Gently press paper to coloured bubbles to make prints. Use different colour another
day
- Encourage imaginative fun — make volcanoes or bubble flowers
- Play 'hide and seek' in the bubbles. Use a straw to blow away bubbles and find hidden
object (eg small toy, key, ping pong ball)
- Slowly and carefully blow the ‘world's biggest bubbles’
Older children and adults with chronic lung disease
Attention
Postural drainage
- Avoid head-down positions in people with enlarged abdomen, liver disease, high BP,
cardiac problems, neurosurgery, raised intercranial pressure, recent facial, head
or neck trauma, recent eye surgery, severe breathlessness, history or symptoms of
reflux
- Need to know which lung is affected, which part contains sputum that needs drainage.
Need full chest exam and x-rays
- Always start treatment with most damaged lung uppermost
- If too hard for person — shorten time spent in drainage position, but ask them to
try and stay in position a bit longer each time they have a go
- Do at least once a day
What you need
- Surface that can be tilted — special bed, couch, stretcher, or copy ideas in pictures
below, make sure person is safe
- Disposable cup or container to spit into, box of tissues
What you do
Postural drainage
- Ask person to lie in position that drains affected part/s of lung for 15–20 minutes,
do breathing exercises at least 6 times in each position
Breathing exercises
Ask person to lie in position that drains affected part of lungs and breathe normally
until comfortable lying in position.
Then do breathing exercises — Active Cycle of Breathing Technique (ACBT)
- Deep breathing
- Slow deep breath in, hold for 1–2 seconds, relaxed breath out
- Repeat 2–3 times — percussion and vibrations can be added
- Then relaxed quiet breathing (breathing control) for a few breaths
- Repeat above cycle
- Huffs, quiet breathing and coughs
- Then ask person to do 1 or 2 huffs
- For a 'huff' ask the person to take a breath slightly bigger than normal and then
force the air out quickly through an open mouth
- Then do relaxed quiet breathing again
- Continue this cycle until sputum has moved up airways far enough to be coughed out
- For a cough — ask the person to take a big breath and cough. Repeat as needed
Repeat all the above until 2 cycles with a dry cough
Supporting resources