What Is Postural Drainage In COPD?

Using Gravity to Clear Airway Secretions

lingula COPD drainage position
Credit: Artwork by Carolyn Russell

Postural drainage is an airway clearance technique that uses gravity to assist in the removal of secretions from the airways. It's used in the treatment of COPD, particularly in patients with chronic bronchitis and bronchiectasis, and is often coupled with chest physiotherapy.

How Is Postural Drainage Performed?

Postural drainage can be done with the assistance of a respiratory therapist, or at home, if a patient’s caregiver is taught how to do it.

There are several different body positions used for postural draining, which vary based on the part of the lungs that need to be drained.

The person performing the drainage uses one of two hand positions depending on the motion required. A cupped hand is used for chest percussion, while a flat hand is used for vibration. It's important to remember to not percuss over bare skin.

The percussion technique should be vigorous and rhythmical, but it should not involve pain. If the patient complains of pain, your hand posture needs to be softened or readjusted in the cupped position. When done correctly, you should hear a hollow sound with each percussion.

The vibration technique is used to gently shake mucus and secretions into the large airways, making them easier to cough up. During vibration, a caregiver should place a flat hand firmly against the chest wall at the lung section to be cleared.

Using a stiff arm, apply light pressure and create a shaking movement, similar to that of a vibrator.

During vibration therapy, the patient should take deep breaths and exhale slowly and forcefully to stimulate a productive cough.

Postural Draining Positions

There are a variety of body positions used during postural drainage, depending upon which part of the lungs the therapist wants to focus.

The anterior upper lobes: The patient should sit upright in a bed or flat surface or lie on their back, while the caregiver percusses and vibrates over the muscular area between the collar bone and very top of the shoulder blades.

The posterior lobes: The patient should sit upright on the side of the bed and lean over a large pillow or exercise ball. The caregiver uses chest percussion and vibration with both hands over the upper back.

The lingula: The patient lies on their right side, hips and legs up on pillows, while the caregiver percusses and vibrates just outside the nipple area.

The middle lobe: The patient lies on their left side, with the right arm up and out of the way, and legs and hips elevated as high as possible, while the caregiver percusses and vibrates just outside the right nipple area.

The lower lobes: The patient lies on their right side, with hips and legs elevated as high as possible on pillows. The caregiver performs chest percussion and vibration over the lower ribs on the left side before repeating on the other side.

The posterior lower lobes: The patient lies on his or her stomach, with the hips and legs elevated by pillows. The caregiver performs chest percussion and vibration at the lower part of the back, over the left and right sides of the spine, careful to avoid the spine and lower ribs.

You can learn more about postural drainage positions to help rid your lungs of excess mucus.

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