Nursing Reviews


Chest Physiotherapy (CPT)


Anatomy and physiology of respiratory system

Air moves through the body in the following order:

Divisions of the Trachea & Bronchi
Lobes & Divisions of the lungs

Physiology of Respiration

Gas Exchange

Indications of Chest Physiotherapy

It is indicated for patients in whom cough is insufficient to clear thick, tenacious, or localized secretions. Examples include:

Contraindications of Chest Physiotherapy

Assessment for Chest Physiotherapy

Nursing care and selection of CPT skills are based on specific assessment findings. The following are the assessment criteria:

Clinical findings and investigations

Techniques in Chest Physiotherapy

1. Percussion

2. Vibration

Procedure: Percussion & Vibration

3. Postural Drainage


Articles required


  1. Use specific positions so the force of gravity can assist in the removal of bronchial secretions from affected lung segments to central airways by means of coughing and suctioning.

  2. The patient is positioned so that the diseased area is in a near vertical position, and gravity is used to assist the drainage of specific segment.

  3. The positions assumed are determined by the location, severity, and duration of mucous obstruction

  4. The exercises are performed two to three times a day, before meals and bedtime. Each position is done for 3-15 minutes

  5. The procedure should be discontinued if tachycardia, palpitations, dyspnea, or chest occurs. The se symptoms may indicate hypoxemia. Discontinue if hemoptysis occurs.

  6. Bronchodilators, mucolytics agents, water, or saline may be nebulised and inhaled before postural drainage and chest percussion to reduce bronchospasm, decrease thickness of mucus and sputum, and combat edema of the bronchial walls, there by enhancing secretion removal

  7. Perform secretion removal procedures before eating

  8. Make sure patient is comfortable before the procedure starts and as comfortable as possible he or she assumes each position

  9. Auscultate the chest to determine the areas of needed drainage

  10. Encourage the patient to deep breathe and cough after spending the allotted time in each position.

  11. Encourage diaphragmatic breathing through out postural drainage: this helps widen airways so secretions can be drained




Lung segment

Position recommended


High Fowler’s

Apical-right upper lobe-anterior segment

Sitting on side of the bed
Supine with head elevated

Left upper lobe-anterior

Supine with head elevated

Right upper lobe-posterior

Side-lying with right side of the chest elevated on pillows

Left upper lobe-posterior

Side-lying with left side of the chest elevated on pillows

Right Middle lobe-anterior segment

Three-fourth supine position with dependent lung in Trendelenburg’s position

Right Middle lobe-posterior segment

Prone with thorax and abdomen elevated

Both lower lobes-anterior segments

Supine in Trendelenburg’s position

Left lower lobe lateral position

Right side-lying in Trendelenburg’s position

Right lower lobe-lateral segment

Left side-lying in Trendelenburg’s position

Right lower lobe-posterior segment

Prone with right side of chest elevated in Trendelenburg’s position

Both lower lobes-posterior segment

Prone in Trendelenburg’s position



Bilateral-Apical segments

Sitting on nurse’s lap, leaning slightly forward flexed over pillow.

Bilateral-middle anterior segments

Sitting on nurse’s lap, leaning against nurse

Bilateral- anterior segments

Lying supine on nurse’s lap, back supported with pillow.


Complications are unusual but include:

4. Coughing

5. Controlled Coughing Technique


Chest physiotherapy is an effective procedure in chronic pulmonary disorders. This is especially helpful for patients with large amount of secretions or ineffective cough.  It is performed by professionally trained nurses in most settings.


  1. Potter Perry. Basic Nursing 6th edn..Mosbi, Missouri, 2006.

  2. Carel TylerCarel Lilli, Pricilla Lemone. Fundamentals of Nursing. Lippincott’s Williams Philadelphia, 2006

  3. Judson, MA, Sahn, SA (1994) Mobilization of secretions in ICU patients. Respir Care 39,213-226.

  4. Wallis C, Prasad A. Who needs CPT? Moving from anecdote to evidence. Arch Dis Child 1999; 80:393-397.

  5. Fedorovich C; Littleton MT. Chest physiotherapy: evaluating the effectiveness. Dimensions of Critical Care Nursing (DCCN), 1990 Mar-Apr; 9(2): 68-74.

This page was last updated on: 09/12/2020