Overview
When Chest Physiotherapy Fits—and When to Pause
Chest physiotherapy is a targeted airway clearance intervention, not an automatic response to every cough.
Chest physiotherapy is a targeted airway-clearance intervention, not an automatic response to every cough. The bedside problem is usually one or both of two bottlenecks: mucus is too abundant or tenacious to move, or the patient cannot generate enough expiratory flow to remove it. Identifying the bottleneck prevents a weak cough from being mistaken for a need for increasingly forceful percussion. CPT is most useful when cough is ineffective or secretions are retained, including with neuromuscular disease, chronic bronchitis or COPD exacerbations, cystic fibrosis, and non-CF bronchiectasis. In cystic fibrosis, daily airway-clearance therapy remains recommended even when the patient is receiving a CFTR modulator; the frequency can be adjusted to the patient’s clinical response. When neuromuscular weakness limits cough, a peak cough flow below 270 L/min indicates ineffective clearance and should prompt a prescribed, assessed plan for mechanical insufflation-exsufflation, commonly called cough assist. Before performing or assisting with CPT, an RPN confirms the treatment plan and works within provincial scope, employer policy, and individual competence. Screen for recent hemoptysis, active bleeding diathesis, rib or vertebral fracture, uncontrolled osteoporosis, or elevated...