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drainage methods

Question
Hello,
I would like to ask, which drainage techniques can be used in a 9-year-old child to make the child more self-dependent. I have to add, that the child cooperates well, does not expectorate a lot of secretion even during exacerbation periods. Currently we perform bronchial drainage in different positions and compression.
Answer
Dear questioner,
from information that provides your question to us it seems that your child is currently using postural drainage combined with either percussion (also known as clapping) or vibrations (also known as shaking). Postural drainage involves the patient adopting various body positions in which gravity facilitates the movement of mucus from specific segments of the lungs into the larger, central airways. Percussion involves rhythmically clapping the chest with cupped hands, and vibrations involves shaking the chest wall by pressing over the draining area in the direction that the ribs move during expiration.
Postural drainage with percussion and vibration is one option, and as you suggest yourself, often means that the patient is reliant on a second person.
Other techniques that can increase the patient's independence include autogenic drainage. This is different to postural drainage. Autogenic drainage involves breathing at different lung volumes to loosen (breaths performed at a low lung volume), mobilize (breaths performed at mid-lung volume) and clear secretions (breaths perfomed at a high lung volume).
Adjunts that can be used to aid airway clearance include PEP (positive expiratory pressure), acapella and flutter.
In studies it came out, that out of all the different airway clearance therapies and devices no one has to be shown to be superior to the other, so that the prescription of a certain kind of physiotherapy should be individualized according to the respective patient. Additionally it can be said that sports and exercise is recommended as an adjunctive therapy for airway clearance and for its additional benefits to overall health.
Regards, prof. dr hab. Wojciech Cichy
14.04.2010