What Is Chest Percussion in COPD?

What to expect when undergoing this procedure

Doctor Auscultating a patient
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In This Article

Chest percussion is a form of physical therapy used frequently in chronic obstructive pulmonary disease (COPD) and other conditions (such as cystic fibrosis) to help clear your airways from mucus. It literally involves percussion on your chest and/or back—your partner or a health care worker will clap you on your chest or back to help loosen the thick mucus in your lungs so you can cough it up. Chest percussion also can be performed using electronic devices or other instruments that vibrate your chest.

Purpose of Test

Conditions like COPD and cystic fibrosis can result in major mucus buildup in your airways, making it hard to take a deep breath. While there are several medications that can help loosen mucus and dilate the airways, one physical procedure is often used—chest percussion, which involves clapping on the back to shake the sticky mucus loose.

Chest percussion is considered a part of chest physical therapy (CPT), which also incorporates postural drainage and vibration, both of which can help loosen and drain mucus. The overall goal of chest physical therapy is to make it easier for you to expel mucus in your airways, which in turn should make it easier for you to breathe.

If you're using postural drainage with chest percussion, you should hold your position for at least five minutes (or as long as your doctor advises) to allow as much mucus as possible to drain from your lungs.

Risks and Contraindications

Chest percussion is a very safe procedure if performed correctly and carefully. Complications are unusual but may include:

  • Damage to internal organs
  • An increase in hypoxemia (a drop in blood oxygen saturation levels)
  • Severe bronchospasm
  • Choking on loosened mucus secretions from other lung lobes

Before the Procedure

Your doctor or respiratory therapist will give you specific instructions on how and when to perform chest percussion. You should always follow the instructions of your healthcare team, but here are some general guidelines on how the procedure typically is performed.

Timing

The best time to perform chest percussion is in the morning since it's likely that your lungs will have built up mucus during the night. If you have a problem with coughing overnight, you can consider performing it right before you go to bed, as well.

Of course, your doctor will advise you on the best times to perform the procedure. Chest percussion works best after a bronchodilator treatment, so you might want to keep that in mind.

It's not a good idea, though, to perform chest percussion right after you've eaten—banging on your chest or back following even a small meal could make you sick.

Another tidbit is that you should combine chest percussion with coughing or other methods to bring up the mucus that's loosened by your efforts.

Location

Chest percussion can be performed while standing, sitting upright, reclining, or lying down on a firm, flat surface. Ask your therapist or healthcare provider which position is right for you.

What to Wear

Note that the procedure shouldn't be performed on bare skin—make sure you're wearing a shirt, or use a towel to cover the area to be clapped upon.

During the Procedure

You'll likely be instructed to perform chest percussion at least once per day in several different positions: seated, on your back with a pillow under your chest so that your head tilts downward, and on your stomach, again with your head tilted downward.

If you're using a mechanical airway clearance device for your chest percussion, your doctor will show you how to use the device.

If you're doing the procedure manually, your partner (or a health care worker) will then clap you on the back of the chest (whichever is exposed) with their hand, quickly and repeatedly.

It's important to use the correct hand position to perform manual chest percussion: the person's hand should be in a cupped position, with fingers and thumb together. When the hand is cupped properly, you'll hear a hollow sound with each percussion.

The percussion should be relatively vigorous and rhythmic—but should not be painful. If pain occurs, the hand may not be properly cupped and should be adjusted.

It's important to perform chest percussion only in specific areas: over the ribs, on the sides of the chest and back; taking care to avoid the breastbone, spine, and lower back, or risk potential damage to internal organs. Your physician can show you exactly where to perform chest percussion.

A Word From Verywell

The ultimate goal of chest percussion is to loosen mucus secretions enough so that they may be coughed up. One of the benefits of this manual technique is that it can be self-performed in adults and children as young as 5 or 6, and empowers people with a tool they can use to help themselves breathe better.

While clinical trials have not successfully illustrated its effectiveness in an evidence-based study, chest percussion remains an important part of treatment plans for many with COPD and cystic fibrosis.

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Article Sources

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  1. Bon Field J. Chest Physiotherapy. Merck Manual Professional Version. Updated March, 2017.

  2. Simonelli C, Vitacca M, Vignoni M, Ambrosino N, Paneroni M. Effectiveness of manual therapy in COPD: A systematic review of randomized controlled trials. Pulmonology. 2019 Feb 7. doi:10.1016/j.pulmoe.2018.12.008

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