A gorgeous 68 year old client was referred to us for chest physio to manage her chronic bronchiectasis.
This client had recently moved from abroad and she had never received chest physio to manage her bronchiectasis. She was intrigued as to how a physio would be able to help her in any way but was open to trying anything as she was quite frustrated with her symptoms.
She was presenting with minimal to no shortness of breath, mild work of breathing and could hold a full conversation without having to catch her breath. She was finding that in the morning she would struggle to clear her chest effectively and always felt as if there were crackles in her chest. This was particularly frustrating for her as it was limiting her ability to go for walks comfortably and go out for coffee with her friends as she would be coughing to clear the crackles then would need to excuse herself to cough up the gunk that was sitting there. She was becoming increasingly frustrated and embarrassed by this.
Her oxygen saturation levels were between 94-96%. Upon auscultation of her chest there were upper airway transmitted sounds (crackles) in her upper lobes bilaterally and right middle lobe. Her cough was wet and occasionally productive of yellow secretions. She felt as if she had crackles in her chest especially upon taking a deep breath.
I carried out a range of treatment techniques in order to clear her chest.
- Deep breathing exercises with thoracic expansion and arm lifts
- Chest physio sequence – this was done lying down in different positions in order to drain different lobes of her lungs.
- Forced expiratory exercises and huffing – this would lead to the client coughing and certain positions were more productive (in other words – more “gunk” came up in certain positions) and in this instance the above sequence was repeated until the gunk was turning white or clear.
Upon reassessment the client was thrilled that she was able to be so productive! She felt as if she could breathe freer and take a big deep breath without feeling the crackles that she would usually feel. Upon re-auscultation, there were no crackles and her oxygenation was sitting around 97%.
Home Exercise Programme:
I asked that the client carry out her exercises 2 times a day.
- Deep breathing exercises + thoracic expansion + arm lifts
- Bubble PEP – I gave her a Bubble PEP which involves blowing bubbles into a bottle of a certain size with a specific straw. This creates pressure and internal percussion within the chest wall which effectively shakes off any gunk that is stuck to the chest wall.
- Forced expiratory exercises and huffing which would lead to coughing.
- I asked that she continue her daily walks at a decent pace – but still able to carry out a conversation.
Our client felt empowered and in control of her condition which she couldn’t remember the last time she had felt that way. She was able to effectively clear her chest and did not experience the ongoing crackles especially in the morning plus she was able to go and have a coffee with her friends and wasn’t embarrassed about constantly coughing as she had cleared her chest prior to leaving. She requires occasional chest physio to clear the deeper and more stubborn secretions that she can’t get up on her own.