suppurative lung disease

1. Student name: Alyaa Zaki Mahmoud
Student ID: 67028
Course name: Physical Therapy For Pulmonar
Course code: CAPU324
Research title: physical therapy for suppurative lung disease
Name of supervisor: DR/Abla Hamed

2. physical therapy for suppurative lung disease
Suppurative lung disease
Definition
It’s a syndrome characterized by a cough and expectoration that is usually excessive , purulent , paroxysmal
and related to posture
Suppurative lung disease include :
• Bronchiectasis
• Cystic fibrosis
• Lung abscess
• pneumonia
General Clinical problems of Suppurative lung diseases:
1-Accumulation of purulent secretions and productive cough.
2- Dyspnea and overuse of accessory muscles of respiration.
3- Limitation of chest movement
4- Reduced exercise tolerance

3. physical therapy for suppurative lung disease
Aims:
 Clear the lung fields.
 Improve strength and endurance of respiratory muscles
 Maintain mobility of the shoulder girdle and thorax
 Improve exercise tolerance
Bronchiectasis
Definition
It is an abnormal and irreversible dilatation of the bronchi , results from chronic airway infection and inflammation
Symptoms and signs of bronchiectasis
• Cough (98%)
• Copious sputum production
• Wheezing
• Dyspnoea
• Fatigue

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Physical therapy management for Bronchiectasis
1-using hot drink may help to liquefy sputum
2- variety of techniques can be used such as
Active Cycle of Breathing Techniques
Physical therapy techniques of airway clearance include the active cycle of breathing techniques, a cycle of the techniques
of breathing control, thoracic expansion exercises, and therefore the forced expiration technique. Breathing control is
normal, gentle tidal breathing at the patient’s own rate and depth, encouraging use of the lower chest and diaphragm,
with relaxation of the upper chest and shoulders. Breathing control is employed between the more active parts of the
cycle to attenuate any increase in airflow obstruction and fatigue.
•Breathing Control (BC): Relaxed diaphragmatic breathing which allows for rest and helps avoid any tightening of airways,
which can make it difficult to clear secretions
•Thoracic expansion exercises (TEE): Deep breathing exercises that help the lungs to expand more effectively and allow air
to get behind secretions so that they can be "pushed" up the airways towards the mouth. The breaths should be slow and
deep with a pause at the end of inspiration then followed by relaxed quiet expiration
•Forced Expiration Technique (FET): This consists of huffing or a sigh, to help move secretions from the smaller to the
larger airways from where they can be cleared more easily

5. physical therapy for suppurative lung disease
Autogenic Drainage
Physical therapy techniques of airway clearance also include autogenic drainage, during which breathing at different
lung volumes and expiration are used to move the mucus. The aim is to maximise expiratory flow
Positive Expiratory Pressure
The positive expiratory pressure device consists of a facemask or
mouthpiece and a 1-way valve to which expiratory resistors are often
attached. The resistor is placed on the expiratory limb of the valve, and thus
the pressure during mid-expiration should be between 10 and 20 cm of
water. this may be measured by inserting a manometer between the valve
and resistor. The patient sits leaning forward along side his elbows supported
on a table. He holds the mask firmly over his nose and mouth and breathes at
tidal volume, with a rather active expiration, for about 6 to 10 breaths.
The lung volume should be maintained by avoiding complete expiration.
Breaths through the mask are followed by the forced expiration technique to
clear secretions that are loosened.

6. physical therapy for suppurative lung disease
The use of positive expiratory pressure in adults with bronchitis and in children
and young adults with cystic fibrosis has been compared with “conventional”
postural drainage. In these studies, over a period of 1 year, positive expiratory
pressure was simpler than conventional physiotherapy in maintaining and
improving lung function and was the well-liked regimen.
Oscillating Positive Expiratory Pressure (Cornet)
The cornet consists of a curved, hard plastic outer tube and mouthpiece with a
flexible latex-free tube. During expiration through the cornet, a positive expiratory
pressure and an oscillatory vibration of the air within the airways is about up.
Coughing or huffing is used to clear secretions mobilized to the central airways.
The patient breathes out through the cornet, following a breath in with a
disruption of two to 3 seconds at the highest of inspiration. Initially, these breaths
are at an approximately normal rate and depth but could even be interspersed
with deeper and more forceful ones. Again, the forced expiration technique is used
to clear secretions that are mobilized. it's recommended that the cornet be used
for 10 to fifteen minutes. The cornet has been shown to be as effective because
the flutter in airway clearance in adults with chronic obstructive pulmonary
disease and to decrease the cohesiveness and viscoelasticity of sputum from
patients with bronchiectasis.

7. physical therapy for suppurative lung disease
Flutter
The flutter is pipe-shaped with a high-density chrome steel ball enclosed during a cone within the bowl of the “pipe.” During
expiration through the flutter, the increase and fall of the ball and its movement along the surface of the cone create a
positive expiratory pressure and an oscillatory vibration of the air within the airways. additionally, the movement of the ball
produces intermittent airflow accelerations.
Percussion
This technique is also known as chest clapping, and is used to help loosen secretions. To perform this technique a cupped
hand is used to clap the chest firmly and rhythmically (over a layer of clothing or a towel)
Exercise
The short and long-term benefits of regular physical activity are well established and the importance of regular physical
exercise as an essential part of the physiotherapy regimen is recognized
Outcome measures to monitor the effect of an exercise program include:
•Field exercise tests: 6 minute walking test, shuttle test
•Cyclo-ergometry
•Treadmill
•Modified Medical Research Council (MRC) scale

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Intermittent Positive Pressure
Breathing Intermittent positive pressure breathing (IPPB), the maintenance of a positive pressure throughout inspiration
(for example, the “Bird”), may be a useful adjunct in the spontaneously breathing patient. IPPB has been shown to
augment tidal volume and to reduce the work of breathing during inspiration. These 2 effects support the use of IPPB to
help in the clearance of bronchial secretions when simpler airway clearance techniques alone are not maximally effective.
It may be administered via a mouthpiece, flanged mouthpiece, or mask.
Cyctic fibrosis
Definition
Developmental anomaly of bronchial tree with abnormally dilated bronchial wall caliber with bronchial cyst formation
Types
• Central congenital cyst
• Peripheral congenital cyst
Signs and symptoms will differ from person to person and these may include:
• Fatigue
• Salty-tasting skin
• Persistent cough with phlegm
• Wheezing and shortness of breath

9. physical therapy for suppurative lung disease
Physiotherapy Management for Cyctic fibrosis
The main aim of physiotherapy is to prevent secondary complications and improve quality of life by removing excessive
mucus secretions, maintain or improve lung function and assist with musculoskeletal therapy where needed
A person suffering from CF will require intensive chest physiotherapy , which include
• Vigorous massage to help loosen the sticky mucus
• Postural drainage: gravity assisted positions to help drainage of secretions and also helps to increase the air movement
or ventilation to different parts of the lungs
• Shaking and Vibrations: This technique consists of several short rhythmical squeezes to the chest while exhaling to
mobilize secretions
• Active cycle of breathing (ACBT)
• Positive expiratory pressure (PEP)
• Exercise
 Benefits of Exercise for the CF patient include
Enhanced fitness levels
Increased sputum clearance
Delay the onset of dyspneoa
Delay declines in pulmonary functio

10. physical therapy for suppurative lung disease
Lung abcess
Definition
is the localized formation of pus usually surrounded by a fibrous capsule within the lung tissue.
Physiotherapy:
Aim:
To promote drainage
Methods: -
Site of abscess is ascertained on x-ray.
Patient is positioned accurately for 10-15 minutes every four
hours.
Shaking is applied on the chest.
Breathing Ex. as to regain breath control after coughing

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Pneumonia
Definition
Pneumonia is an infection within the tissues of the lungs. It causes fluids and inflammatory mediators to proliferate within
the lung tissue and air sacs. This stops the lungs from working properly
Types of pneumonia
Hospital-acquired pneumonia (HAP)
This type of bacterial pneumonia is acquired during a hospital stay. It are often more serious than other types, because the
bacteria involved could even be more resistant to antibiotics.
Community-acquired pneumonia (CAP)
Community-acquired pneumonia (CAP) refers to pneumonia that’s acquired outside of a medical or institutional setting.
Ventilator-associated pneumonia (VAP)
When people that are employing a ventilator get pneumonia, it’s called VAP.
Aspiration pneumonia
Aspiration pneumonia happens once you inhale bacteria into your lungs from food, drink, or saliva.

12. physical therapy for suppurative lung disease
Physical therapy methods for Pneumonia
 stays within the sauna 1-2 times a week; spa procedures
 Special breathing and coughing exercises to clear mucous and improve lung ventilation
 Specialized manual chest therapies to assist loosen mucus
 General mobility/exercise programs to improve endurance
 Use of cough assist devices to help clear mucous
 Education for you and your family

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