Chest physiotherapy (CPT)

Chest physiotherapy (CPT), also known as chest physical therapy, is a basic hands-on treatment for people whose lungs are clogged with mucus. When used correctly, CPT can help loosen and drain unwanted material from the lungs. The basic motions needed for CPT involve light percussion and vibration, usually with the hands, on different parts of the torso. CPT can be performed by people with minimal training, and in some cases, patients can perform CPT on themselves. CPT is a treatment for a variety of diseases affecting the lungs, such as cystic fibrosis.

Background

The human lungs are an important part of a healthy life. Most people have two lungs, a right and a left. The right lung has three lobes that are interconnected, and the left lung has two lobes. Each lobe has its own passageways for air, sacs to hold air (called alveoli), and blood vessels that allow oxygen and carbon dioxide to pass between blood and air. The lungs and their lobes are essential for moving and using air that the body needs to function.

Many illnesses target the human lungs. Among these illnesses are cystic fibrosis, pneumonia, bronchiectasis, lung abscesses, and some neuromuscular disorders. These illnesses may cause mucus or other materials to gather in the lungs. Mucus is a slippery liquid that occurs naturally in the lungs and other parts of the body. In normal quantities, mucus is helpful for protecting and lubricating parts of the body, such as the airways leading to and from the lungs.

When too much mucus gathers in or near the lungs, it can obstruct airflow and potentially cause lasting damage. Most lungs are equipped with different means of clearing out excess mucus, such as small hairs called cilia that can push out unwanted materials. The act of coughing is also helpful in removing mucus. However, some illnesses cause so much mucus to gather in the lungs that natural defenses cannot cope with it.

One serious disease relating to mucus in the lungs is cystic fibrosis. Cystic fibrosis is a genetic disease that causes unusually sticky and thick mucus to gather in the lungs. This mucus can clog air tubes, leading to difficulty in breathing, and retain bacteria and other harmful materials that cause infections. Infections may involve coughing and shortness of breath, and severe infections may permanently damage the lungs. The word fibrosis refers to scar tissue that may build in damaged lungs, further reducing lung strength and capacity. Severe cystic fibrosis is potentially life-threatening.

Although no known cure exists for cystic fibrosis and the condition requires ongoing treatment, people with this and other diseases affecting their lungs have many treatment options. Medications, surgeries, or transplants may help clear airways, restore proper lung function, and decrease infections. Many patients with chronically clogged lungs also have turned to less intensive forms of treatment, such as hands-on therapies that can be performed at home.

Overview

Chest physiotherapy, also known as chest physical therapy or CPT, is a popular technique for loosening and draining mucus and other unwanted materials from the lungs. People can perform CPT with minimal training. Some patients seek CPT at medical facilities from physical therapists or nurses. However, many patients arrange to have family members or friends perform CPT in their homes. In some cases, patients can perform their own CPT.

CPT involves light percussion, usually with the hands, in a clapping or vibrating motion on the patient’s torso. During this activity, the patient may breathe deeply or cough to help dislodge mucus. The patient, usually sitting in a chair or lying on a flat surface, may assume several positions. Changing positions allows different lobes of the lungs to face downward, giving them the opportunity to drain mucus into large airways. There, the mucus can more easily be coughed or huffed out of the lungs.

Different positions target different lobes. Upper lobes are generally drained best in a sitting position. The patient may sit in a chair with their body at different angles while the therapist creates a light percussion on the upper back or the area between the shoulder blades and collarbone. Upper lobes can also drain in a horizontal position, with the patient lying flat while the therapist percusses the pectoral area.

Right and left lobes are often treated with the patient lying on a flat surface, assuming different positions, with the affected area elevated to help drain the specific part of the lung, and the body and the head are sufficiently supported. Percussion along the muscles under the arm can help drain those lobes. Lower lobes are often treated from the horizontal position as well. Patients may lie on their side or on their stomach, while the therapist percusses their back or side.

Most percussion involves the clapping of a hand on the affected area. Therapists usually use a cupped hand that matches the curve of the body and helps soften the blow to avoid pain. Clapping usually lasts for about three to five minutes and follows a steady beat. Clapping often precedes briefer periods of hand vibrations. To vibrate the patient, therapists usually place their hands flat on the affected area, apply pressure, and then make a shaking motion. The entire session will usually last about thirty minutes but may vary depending on the severity of the symptoms and the patient’s care plan. Following the treatment, the patient may be able to force out some dislodged mucus by coughing or huffing.

CPT is widely considered a safe form of therapy as long as practitioners observe a few safety rules. Clapping must be done properly to avoid causing pain. Similarly, therapists should not clap bony areas of the body, such as the spine or lower ribs, which can cause injury, especially to children. Clapping on the stomach may cause nausea, and clapping on the lower back can endanger organs such as the kidneys and liver. Some people have adopted routine CPT into their lifestyles and developed ways to increase their comfort or incorporate enjoyable activities, such as listening to music or watching television, during CPT.

In 2024, the US Food and Drug Administration approved Alyftrek for eligible people with cystic fibrosis aged 6 years and older, reflecting continued advances in mutation-targeted treatment. Technologies in the 2020s, such as high-frequency chest wall oscillation vests, are sometimes used as alternatives to manual CPT to improve mucus clearance.

Bibliography

“Basics of Lung Care.” Cystic Fibrosis Foundation, www.cff.org/Life-With-CF/Treatments-and-Therapies/Airway-Clearance/Basics-of-Lung-Care. Accessed 20 Mar. 2026.

“CG-DME-43 High Frequency Chest Compression Devices for Airway Clearance.” Wellpoint Clinical UM Guideline, Wellpoint, www.provider.wellpoint.com/medpolicies/wellpoint/active/gl_pw_d073857.html. Accessed 20 Mar. 2026.

“Chest Physical Therapy.” Cystic Fibrosis Foundation, www.cff.org/Life-With-CF/Treatments-and-Therapies/Airway-Clearance/Chest-Physical-Therapy. Accessed 20 Mar. 2026.

“Chest Physiotherapy Treatment (CPT).” Cincinnati Children’s Hospital Medical Center, Nov. 2024, www.cincinnatichildrens.org/patients/child/encyclopedia/treat/respiratory/chest-physiotherapy. Accessed 20 Mar. 2026.

“Cystic Fibrosis.” Mayo Clinic, 7 Dec. 2024, www.mayoclinic.org/diseases-conditions/cystic-fibrosis/diagnosis-treatment/drc-20353706. Accessed 20 Mar. 2026.

“Cystic Fibrosis.” MedlinePlus Genetics, U.S. National Library of Medicine, www.medlineplus.gov/genetics/condition/cystic-fibrosis/. Accessed 20 Mar. 2026.

“Drug Trials Snapshot: ALYFTREK.” U.S. Food and Drug Administration, 20 Dec. 2024, www.fda.gov/drugs/drug-approvals-and-databases/drug-trials-snapshot-alyftrek. Accessed 20 Mar. 2026.

Levine, Andrea R., and William R. Grier. “Chest Physiotherapy.” Merck Manual, Mar. 2024, www.merckmanuals.com/professional/pulmonary-disorders/pulmonary-rehabilitation/chest-physiotherapy. Accessed 20 Mar. 2026.

“Patient Instructions: Chest Physical Therapy (CPT) for Children Less Than 2 Years Old.” Children’s Hospital of Philadelphia, www.chop.edu/patient-family-ed/patient-instructions-chest-physical-therapy-cpt-children-less-2-years-old. Accessed 20 Mar. 2026.

Pountney, Teresa E. Physiotherapy for Children. Butterworth Heinemann Elsevier, 2007.