Abstract
Background: Manual chest wall compression (CWC) during expiration is a technique for removing airway secretions in patients with respiratory disorders. However, there have been no reports about the physiological effects of CWC in patients with chronic obstructive pulmonary disease (COPD). Objective: To compare the effects of CWC on expiratory flow rates in patients with COPD and asymptomatic controls. Method: Fourteen subjects were recruited from among patients with COPD who were receiving pulmonary rehabilitation at the University Hospital (COPD group). Fourteen age-matched healthy subjects were also consecutively recruited from the local community (Healthy control group). Airflow and lung volume changes were measured continuously with the subjects lying in supine position during 1 minute of quiet breathing (QB) and during 1 minute of CWC by a physical therapist. Results: During CWC, both the COPD group and the healthy control group showed significantly higher peak expiratory flow rates (PEFRs) than during QB (mean difference for COPD group 0.14 L/sec, 95% confidence interval (CI) 0.04 to 0.24, p<0.01, mean difference for healthy control group 0.39 L/sec, 95% CI 0.25 to 0.57, p<0.01). In the between-group comparisons, PEFR was significantly higher in the healthy control group than in the COPD group (-0.25 L/sec, 95% CI -0.43 to -0.07, p<0.01). However, the expiratory flow rates at the lung volume at the PEFR during QB and at 50% and 25% of tidal volume during QB increased in the healthy control group (mean difference for healthy control group 0.31 L/sec, 95% CI 0.15 to 0.47, p<0.01: 0.31 L/sec, 95% CI 0.15 to 0.47, p<0.01: 0.27 L/sec, 95% CI 0.13 to 0.41, p<0.01, respectively) but not in the COPD group (0.05 L/sec, 95% CI -0.01 to 0.12: -0.01 L/sec, 95% CI -0.11 to 0.08: 0.02 L/sec, 95% CI -0.05 to 0.90) with the application of CWC. Conclusion: The effects of chest wall compression on expiratory flow rates was different between COPD patients and asymptomatic controls.
Highlights
Manual chest wall compression (CWC) during expiration is a technique for removing airway secretions[1,2]
CWC appears to be less effective in increasing absolute expiratory flow rates in chronic obstructive pulmonary disease (COPD) patients than in healthy subjects, the peak expiratory flow rates (PEFRs), which is more effective for removing secretions, did increase in the COPD group
In the between‐group comparisons, Vt, PIFR, PEFR, Vt/Ti, and Vt/Te were significantly higher in the healthy control group than in the COPD group
Summary
Manual chest wall compression (CWC) during expiration is a technique for removing airway secretions[1,2]. It has been reported that many physical therapists often use manual chest physical therapy techniques in patients with acute exacerbations of chronic obstructive pulmonary disease (COPD)[14]. It is great of importance for physical therapists to know the physiological effects of CWC in patients with COPD. There have been no reports of the physiological effects of CWC in patients with COPD
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