“A STUDY ON EFFICACY OF ACTIVE CYCLE OF

BREATHING TECHNIQUE AND POSTURAL

DRAINAGE IN PATIENTS WITH BRONCHIECTASIS– A
COMPARATIVE STUDY”

Submitted for the practical fulfillment of the

Requirements for the degree of

BACHELOR OF PHYSIOTHERAPY (BPT)

SEPTEMBER – 2023
BY

NADIHA ANJUM
Reg. No.1808349038
Submitted to

KNR University of Health Sciences,

Warangal.

NAVODAYA COLLEGE OF PHYSIOTHERAPY

P.O.BOX: 21, Bhageeratha Colony,
Mahabubnagar – 509001{T.S}
 CERTIFICATE

NAVODAYA COLLEGE OF PHYSIOTHERAPY

P.O.BOX NO.21,Bhageeratha Colony,
Mahabubnagar– 509001{T.S}

This is to certify that the project “A STUDY ON EFFICACY OF

ACTIVE CYCLE OF BREATHING TECHNIQUE AND

POSTURAL DRAINAGE IN PATIENT WITH

BRONCHIECTASIS – A COMPARATIVE STUDY” was done by

NADIHA ANJUM with Reg.No.1808349038 as a partial fulfillment of

Bachelor of Physiotherapy in Navodaya College of Physiotherapy,

Mahabubnagar during the year SEPTEMBER-2023 submitted toKNR

University of Health Sciences,Warangal.

Internal Examiner External Examiner

 ENDORSEMENT BY THE PRINCIPAL

This is to certify that the project entitled as “A STUDY ON

EFFICACY OF ACTIVE CYCLE OF BREATHING TECHNIQUE
AND POSTURAL DRAINAGE IN PATENTS WITH
BRONCHIECTASIS – A COMPARATIVE STUDY” was done by
NADIHA ANJUM with Reg.No.1808349038 as a partial fulfillment of
Bachelor of Physiotherapy in Navodaya College of Physiotherapy,
Mahabubnagar during the year SEPTEMBER - 2023 submitted to
KNR University of Health Sciences,Warangal.

Date:
Place : Mahabubnagar
Signature of Principal

DR.G.NAVEEN CHANDRA GOUD,

MPT, ORTHOPAEDIC

Principal,

Navodaya College of Physiotherapy,

Mahabubnagar.
 ENDORSEMENT BY THE GUIDE

This is to certify that the project entitled as “A STUDY ON

EFFICACY OF ACTIVE CYCLE OF BREATHING TECHNIQUE
AND POSTURAL DRAINAGE IN PATENTS WITH
BRONCHIECTASIS – A COMPARATIVE STUDY” was done by
NADIHA ANJUMwith Reg.No.1808349038 as a partial fulfillment of
Bachelor of Physiotherapy in Navodaya College of Physiotherapy,
Mahabubnagar during the year SEPTEMBER - 2023 submitted to
KNR University of Health Sciences,Warangal.

Date:
Place : Mahabubnagar

SIGNATURE OF THE GUIDE

DR.G.NAVEEN CHANDRA GOUD

(PRINCIPAL)

NAVODAYA COLLEGE OF PHYSIOTHERAPY

MAHABUBNAGAR
 DECLERATION BY THE CANDIDATE

I hereby declare that the KNR University of Health Sciences,

WARANGAL, Telangana shall have the rights to preserve, use and
disseminate this dissertation/thesis in print or electronic format for
academic / research purpose.

Date:

Place: Mahabubnagar

SIGNATURE OF THE CANDIDATATE

KNR University of health Sciences,Warangal

 ACKNOWLEDGEMENT

“Without crossing the worst situations, no one can touch the best
corners of life”

It is esteemed pleasure to present this project work on“A STUDY ON

EFFICACY OF ACTIVE CYCLE OF BREATHING TECHNIQUE AND
POSTURAL DRAINAGE IN PATIENTSWITH BRONCHIECTASIS – A
COMPARATIVE STUDY”and I whole-heartedly thank each and every one
who helped me in this task.
At the outset, I take this opportunity to thank all those who have
been instrumental in helping me carry out this project. First and
foremost, I would like to thank the ALMIGHTY for all the blessings he
has bestowed on me.

With deep sense of gratitude, I thank my Principal, Esteemed

Professor, Dr. G.NAVEEN CHANDRA GOUD M.P.T-ORTHO , for
her patience and valuable guidance, unflinching support, keen
surveillance, constructive inputs that has been instrumental in molding
me as a professional and motivating me throughout the process and also
for the help rendered in completing this project.

I am thankful to my project guide Dr. Naveen chandra goud , who

helped me and rendered his valuable time to give me the knowledge
and information regarding the collection of the material and whose
suggestions and guidance enlightened me on the subject.

Words may never describe the sacrifices my parents have made for
me, without whose love, affection, constant support and trust, I would not
have been where I am today. Special thanks to my Graduate colleagues
seniors and juniors for being there always when 1 needed them.

I express my sincere thanks to all the patients for their participation in this
study.I thank one and all who have been instrumental in helping me
complete This project.

NADIHA ANJUM
 INDEX
Sl.No. CONTENTS PAGE No

1. INTRODUCTION 1-16

2. AIM OF THE STUDY 17-18

3. NEED OF THE STUDY 19-20

4. HYPOTHESIS 21-22

5. REVIEW OF LITERATIRUE 23-26

SUPPORTIVE MATERIALS
A) ANATOMY
6. B) AETIOLOGY 27-35
C) SIGNS AND SYMPTOMS
D) TREATMENT

7. MATERIALS & METHODOLOGY 36-52

8. DATA ANALYSIS 53-57

9. RESULT 58-59

10. DISCUSSION 60-61

11. CONCLUSION 62-63

12. 64-65
LIMIATIONS & RECOMMENDATIONS

13. BIBILOGRAPHY 66-69

ANNEXURE

A.CONSENT FORM 70-82

14.
B.ASSESSMENT CHART
C.MEASUREMENT TOOL
D.CASE STUDY
INTRODUCTION

1
 INTRODUCTION
Bronchiectasis is one of the most common diseases in the rural&
Industrial areas of India. There are reports of high prevalence in
relatively isolated populations with process to health care. High
rates of respiratory tract infections during childhood.
Bronchiectasis is an abnormal dilatation of the bronchi
associated with obstruction & Infection. Clinically Bronchiectasis is
defined as an abnormal dilatation of medium size bronchioles
generally associated with previous, chronic necrotizing infections.

The etio-pathogenesis of Bronchiectasis is related to

bronchial obstructions, infections or both in a large majority of
patients.
The condition most commonly affects the lower lobes, the
lingual & then the middle lobes. It tends to affect the left lung
more than right; although 50% of cases are bilateral.

It is an uncommon disease with the potential to cause

devastating illness including repeated respiratory infections
requiring antibiotics, disabling productive cough, shortness of
breath, & occasional haemoptysis.

Typical sings, & symptoms include sputum overproduction,

fever, pleurisy, dyspnea, chronic cough, haemoptysis, added

2
sounds, clubbing, pulmonary junction test of patients with
localized bronchiectasis show reduction in FEV1, maximal mid
expiratory flow rate maximal voluntary ventilation (MVV) diffusing
capacity & increase in residual volume. Spirometry often shows a
limitation of airflow with a reduced ratio of forced expiratory
volume in one second (FEV1) to forced vital capacity (FVC) a
normal or slightly reduced FVC and a reduced FEV1 an air-ways are
blocked by mucus with forced exhalation pneumonitis in the lung.

The most accepted treatment protocol preferred for

Bronchiectasis nowadays includes oral antibiotic therapy
according to the severity of the exacerbation & mucus clearance
by means of bronichial hygiene assistive devices surgical
resection, chest physiotherapy like breathing exercises, postural
drainage, high-frequency chest compression, forced expiratory
techniques. etc.,

The removal of respiratory secretions in patients with

bronchiectasis is beneficial physical means such as gravitational
postural drainage and the forced expiration technique (FET) used
for chest physiotherapy may also be effective.

In addition to the control of

- Cough
- postural drainage

3
- chest physiotheraphy thinning and loosening of secretions. The
administration of a bronchodialator and in holed corticosteroids
has been part of maintenance therapy & ACBT could an effective
method of airway clearance technique in Bronchiectasis clearing
secretionsimproving lung functions. Techniques can be used
stable COPD.

- Pulmonary Function Test

- Oxygen Saturation (Spo2)

- Peck expiratory flow rate can measure the effects of postural

drainage and active cycle of breathing techniques Rene Lannac
made the first description of bronchiectasis in 1819 (European
Journal of cordio-Thoracic surgery 2001)

CAUSES:- Postural drainage with Bronchiectasis has both

congenital & acquired causes, with the later more frequent.

4
ACQUIRED CAUSES:-
- Pneumonia
- Opportunistic infection
- Crohn’s diseaseTuberculosis
- Inflammatory bowel disease
- Respiratory infections
- Aspiration pneumonia
- Pulmonary aspiration
- Rheumatoid arthritis
- Inhalation of toxic gases
- Alcoholism
- Heroin
- Allergic bronchio pulmonary aspergillosis
- Various allergies
- Smoking
- Hay fever
- Chronic bronchitis

CONGENITAL CAUSES:-
- Cartagena’s syndrome
- Cystic fibrosis
- Young’s syndrome
- Sino pulmonary infection
- α-1 antitrypsin deficiency
- Williams – Campbell syndrome
- Primary immune deficiencies.

5
 INCIDENCE & PREVALENCE

According to NATIONAL HEART, LUNG, BLOOD INSTITUTE

1999, Death rate extrapolations for U.S.A. for Bronchiectasis was
969 peryear; 80 per month’ 18 per week; 2 per day.

According to STARSHIP CHILDREN’S HEALTH CLINICAL

GUIDELINES –in 2000 a retrospective review of children attending
the bronchiectasis clinic found a crude prevalence rate 1: 6000 in
Auckland paediatiatric population. In 2012 March, >160 children
are reported in STARSHIP BRONCHIECTASIS CLINIC statistics for
Bronchiectasis. In England 2008-09, 39% of hospital consultant
episodes for Bronchiectasis were men and 61% were woman.

In India, It was the recent finding of a 10 fold increase in

Bronchiectasis prevalence in persons with high exposure to
arsenic caused skin lesions in west Bengal in 2005, The prevalence
was higher among women than men 71 Vs 32/1,00,000 &
increased markedly with age 4/1,00,000 for people age 18-34
years & 272/1,00,000 for those aged 75 (or) over.

In UK a full time single handerd practice of 2500 patients will

have one or two patients with Bronchiectasis.

6
PATHOPHYSIOLOGY:-
All causative conditions impair airway clearance mechanisms
and host defences resulting in an inability to clear secretions.
Which in turn, predisposes patients to chronic infection and
inflammation as a result of frequent infection airways become
inspissated with viscous mucous containing inflammatory
mediators and pathogens and slowly become dilated. Scarred &
distorted. Histologically. Bronchial walls are thickened by edema,
inflammation and neovascularisation, destruction of surrounding
interstitium & alveoli causes fibrosis, emphysema or both.
Endobronchial tuberculosis commonly leads to bronchiectasis,
either from bronchial stenos is or secondary fraction from fibrosis.

CLINICAL FEATURES OF ADULTS:-

- Cold
- Chronic cough
- Fever
- Purulent sputum
- Dyspnea
- Wheezing
- Haemoptysis
- Halitosis
- Low grade fever
- Abnormal breathing
- Finger clubbing
- Abnormal breath sounds
- Hypoxemia
- Pulmonary hypertension
- Heart failure

7
CLINICAL FEATURES OF CHILDREN:-
- Conducted sounds Left, Right lungs
- Wheezing
- Dyspnea (creeps)
- Spo2 (decrease)
- Heart rate (increase)

INVESTIGATIONS:

Diagnosis is based on a history, physical examination and

radiologic testing beginning with chest X-Ray.
X-Ray findings suggestive of bronchiectasis include scattered
irregular opacities caused by mucous plugs, honey combing and
rings and tram lines caused by thickened airways located
perpendicular to X-Ray beam.

High resolution CT is the test of choice for defining the

extent of Bronichectasis Cysts (Sometimes appearing as grape like
clusters) scattered mucous plugs & airways that are dilated >1.5
times the diameter of nearby blood vessels can also be seen.
Dilated medium sized bronchi may extend almost to the pleurae
pulmonary function tests can be helpful for documenting baseline
function and for following the progression of diseases over time.
Bronchiectasis causes air flow limitation reduced forced
expiratory volume in 1 second (FEVI) and forced vital capacity.

8
 LABORATORY FINDINGS:-
Blood Tests:-
- CBP
- CRP
- ESR ,ABG
MEDICAL MANAGEMENT:-

Bronchodilator medications – inhaled as aerosol sprays or

taken orally. Bronchodilator medications may help to relieve
symptoms of Bronchodilator by relaxing and opening the airway
in the lungs. Steroids can help relieve symptoms of
Bronchodilator. Overtime however inhaled steroids can cause side
effects such as weakened bones, high blood pressure, diabetes
and cataracts, antibiotics are useful to fight respiratory infections
caused by Bronchodilator mucus thinner & expectorants help to
loosen and clear sections from the lungs. Improving airway
clearance

Encourage hydration 2 to 3 day’s unless contraindicated

humidification may be used to loosen secretions – by face mask or
with oxygen coughing techniques chest physiotherapy position
changes oxygen therapy administered to meet patient needs.

9
 PHYSIOTHERAPY MANAGEMENT

Chest physical therapy techniques consists of “CLAPPING” or

“PERCUSSION & VIBRATION”. It involves pounding over the chest
and back with the hands or a device to loosen the mucous from
the lungs and to initiate the cough. The chest physical therapy is
advised3 or 4 times per day. It is also consists of “POSTURAL
DRAINAGE” this lets gravity and force help drain the mucous from
the lungs. Same people find chest physical therapy difficult or
uncomfortable to do. Several devises have been developed that
may help with chest physical therapy.

The devices include an electric chest clapper known as a

mechanical precursor. A removable INFLATABLE- THEROPY VEST
that was high frequency air waves to force the mucous that is
deep in the lungs. A FLUTTER device a small hand held device that
is used to breathe out through.

Postural drainage removes mucus from certain parts of the

lungs by using gravity and proper positioning to bring the
secretions in to the throat where it is easier to remove them. The
lungs are divided in to segments called lobes the right lung is
divided in to three lobs right upper lobe, right middle lobe and
right lower lobe while the left lung has only two lobes.

10
* A POSITIVE EXPIRATIRY PRESSSORE:-
Mask that creates vibrations that helps to break the mucous
lose from the airway walls several methods like autogenic
drainage and active cycle of breathing technique are used in the
chest physical therapy.

* AUTOGENIC DRAINAGE:-
It is performed with patient made to sit and relax with neck
slightly extended. Begin with same gentle relaxed breaths known
as breathing control. Take a very slow deep breath in through the
nose to the absolute maximum possible pause at the end of the
full breath with mouth slightly open and count for 3-4 seconds.
Start by sitting in a comfortable upright position. Breath out
through the mouth. This should be active (and feel for tummy
mussels frighten) but should not be forced. Instruct the patient
listen and feel for secretions cracking as breath out.

* UNSTICK SECRETIONS:-
Breath as much air out of their chest as they can then take a
small breath in using their tummy feeling their breath at the
bottom of their chest. They may hear secretions start to crackle
resist any desire to cough repeat you at least 3 breaths.

11
* COLLECT SECRETIONS:-
As the crackle of secretions starts to get louder change to
medium sized breaths in feel the breaths more in the middle of
their chest.

* EVACUATE SECRETIONS:-
When the crackles are louder still, take long, slow, full
breaths in to their absolute maximum. Repeat for at least 3
breaths. Follow with gentle but active huffs – this may be enough
to clear secretions and a cough if needed.

ACTIVE CYCLE OF BREATHING – TECHNIQUE:-

With back support. Try to maintain a god breathing pattern
with relaxed shoulders and neck. Try to breathe in through the
nose and act through the mouth. Breathing out should be slow,
like “sighing out”. This minimizes any wheezing.

* BREATING CONTROAL:-
Rest one hand on abdomen, keeping shoulders and upper
chest relaxed and allow their hand to raise gently as they breathe-
in. If they imagine air filling the abdomen like a balloon this may
help. Over a few seconds gradually increase depth of breathing
while maintaining relaxation. Breathing control is an essential part
of the cycle to allow rest.

12
 * DEEP BREATHING EXERCISES:-
Take 3 – 4 deep breathing allowing the lower chest to
expand. Try to ensure neck and shoulders remain relaxed. At the
end of the breath in hold the breath in hold the air in for 3
seconds. Let the air out gently.

* FORCED EXPIRATION TECHNIQUE / HUFF:-

“Huffs” are combined with breathing control and they were
asked to take a half breath in and blow air out steadily through an
open mouth. Follow this with breathing control as secretion
moves in to larger airways. Take a deep breath in and blow air out
again through an open mouth. A typical cycle consists of
breathing control 3 – 4 deep breaths. Breathing control, forced
expiration technique Huff.

* SURGICAL MANAGEMENT:-
The following are the indications for surgery:
- The disease is localized to one lung or one segment and is not
amenable to medical therapy.
- Socio-economic factors such as non-compliance by the patient.
- Uncontrollable haemoptysis in which the site of origin of blood
may be detected by emergency bronchoscopy and surgical
resection has to be planned.
- To remove an obstructive lesion that tends to perpetuate the
condition.
- To reduce the area of infection even in bilateral diseased,
sometimes surgical resection may have to be done on the more

13
affected side. With a view to reducing the surface area of
infection.

* GENERAL THERAPY:-
- Patients should stop smoking
- Patients should avoid second hand smoke
- Patients should have adequate nutrition with
supplementation.
- Immunizations for measles, rubella and pretests should be
confirmed.
- O2 therapy is reserved for patients who are hypoxemic with
severe disease and end stage complications such as
carpulmonalae.

This study was designed to compare the immediate effects

of active cycle of Breathing technique and conventional chest
physical therapy in postural drainage in subjects with
bronchiectasis.

14
15
16
 AIM
OF
STUDY

17
AIM OF THE STUDY:

The aim of the study is to compare the immediate effects of

active cycle of breathing technique and conventional chest

physiotherapy in postural drainage in patient with subject

Bronchiectasis.

18
NEED OF THE

STUDY

19
NEED OF THE STUDY:

The inference of this study help to refine the principles to

prescribe therapeutic module of exercises in order to improve the

sputum clearance and peak expiratory flow rate in subjects with

postural drainage patient in bronchiectasis.

20
HYPOTHESIS

21
 HYPOTHESIS

NULL HYPOTHESIS:-

There is no significant difference between the immediate

effects of active cycle of breathing technique and conventional

chest physiotherapy in subjects with – postural drainage in

patient with bronchiectasis.

ALTERNATIVE HYPOTHESES:-

There is significant difference between the immediate

effects of active cycle of breathing technique and postural

drainage in patients with bronchiectasis.

22
 REVIEW

OF

LITERATURE

23
 REVIEW OF LITERATURE
* “Nick HT Ten Hacken et.al, (2010)” has given the definition
diagnosis for postural drainage bronchiectasis.
* “Notaranglelo et.al, (2010)” has given the causes
forbronchiectasis
* “United States National Heart, Lung, Blood institute” has given
the incidence and prevalence of bronchiectasis in USA

* “British Thoracic society (2010)” has given the physical therapy

techniques for airway clearance and their guidelines in non-cystic
fibrosis bronchiectasis.

* Marian C, Mazzocco, (2010), found that conventional chest

physiotherapy was safe and well floated and assisted the patients
in mobilizing their sputum.

* Madeline Vann, (2010), stated that peak flow meter is the best
assessing tool for airway obstruction.

* Canadian Lung association (2010) stated that conventional

physiotherapy was more effective in the treatment of
bronchiectasis.

* Nafeez Syed ef.al (2009), stated that active cycle of breathing

was more comfortable than conventional physiotherapy in
bronchiectasis & postural drainage patient with bronchiectasis.
* University of California san Francisco (2009), has given the
medical management for bronchiectasis.
* Joshna a bendiff, (2008), has given the pathophysiology of
bronchiectasis.
* Baldwin B Fink, (2007), has given the physical therapy
techniques used for airway clearance to maintain the bronchial
Hygiene.
* Hristara-Papadopulou A (2007), stated that active cycle of
Breathing Technique contributes effectively in the sputum
clearance from the peripheral Bronchopulmanary segments and
enhances the mucociliary clearance in cystic fibrosis.

24
* Jamil Ali Moiz, (2007), stated that autogenic drainage and
active cycle of breathing technique improves O2 saturation without
causing any desirable effects on Heart rate, respiratory rate and
Breathlessness in COPD patients.
* Guha Mazumder ef.al. (2006), has given the prevalence of
bronchiectasis cases in India.
* Mc Cool FD et.al. (2006), have given the ACCPevidence-based
clinical practice guidelines for chest physical therapy for airway
clearance to improve lung mechanics and gas exchange and
prevent infection.

* Dold ME Prasad SA. & Chrom Respir Dis (2005), physiotherapy

management of cystic fibrosis routine airway clearance therapy
Act.

* Dosman CF Jones RL. High frequency chest compression –

(2005), pulmonary function and wx.piratory lung volume and
quality of life.

* Pryor. Jennifer, (2004), stated that physical therapy techniques

can be used to augment mucociliary clearance.
* Ruelings. Adams C.clase to the vest (2003) anovel way to keep
airways clear. Patient tolerance and acceptance & staff time and
lobor savings using high frequency chest compression.
* Van der schans cp: (2002), Airway clearance assessment of
techniques pediatric respire Rev-mucus hyper secretion patent
with pulmonary disease.
* Fink JB, Mahlmeister MJ (2002), High frequency oscillation of
the airway & chest wall growing body of basic research and clinical
study.
* Sl.Hill et.al (1991) stated that physical therapy techniques have
been developed which are effective comfortable and can be used
independent of an assistant in the majority of adolescents and
adults.

25
* WR. Douma Ef.al (1997) concluded that mean peak flow values
measured with frequently used mini-wright’s peak – flow meter
are still reliable after 5-years of use.
* Sutton P ef.al, (1994), stated that forced expiratory technique
resulted in the movement of secretions proximally from all regions
of the lung in patient with hyposecrtion.
* Webber (1993), stated that huffing from a mid-lung volume
and continued down to low-lung volume will move secretions from
peripheral to the upper airways.

26
Supportive
materials

27
1.ANATOMY

Bronchiectasis is a chronic lung disease identified by persistent and

lifelong widening of the bronchial airways and weakening of the function
mucociliary transport mechanism due to repeated infection. These
airway changes allow for easier bacterial invasion and extra mucus
pooling in the widened airways, making them prone to infection[1].

The condition is characterised by a persistent cough with excess

amounts of mucus and, frequently, airflow obstruction together with
episodes of worsening symptoms.[2]Bronchiectasis involves
inflammation of the airway walls, specifically the bronchial walls [4]. The
main area that is affected in bronchiectasis is the bronchi [4]. For more
detailed anatomy see Lung Anatomy

The cilia are also damaged in bronchiectasis and the mucociliary

clearance of mucus is adversely affected. NB. Cilia line the airway and
are attached to the epithelium. They are hair-like with tiny hooks on the
tip to grab the mucous and help move the mucus up to the throat

28
29
2.ETIOLOGY

Etiology
The cause of bronchiectasis is not always known. Some conditions
known to cause bronchiectasis that affect or damage airways are:

Conditions that damage the airways, raising the risk of lung infections.
For example: Allergic bronchopulmonary aspergillosis; pneumonia;
measles; inherited disorders eg Primary Ciliary Dyskinesia, Cystic Fibrosis
Immunodeficiency: predisposes the person to lung infections.
Pulmonary Diseases eg asthma, COPD
Lung infections: may cause damage to the walls of the airways, for
example tuberculosis (TB), whooping cough, measles, pneumonia, or
fungal infections, particularly in childhood.
Conditions that cause an airway blockage, such as a growth or a
noncancerous tumour, regurgitated stomach acid, or inhaled objects
that become stuck and block an airway

3. SIGNS AND SYMPTOMS

At first, you may have no symptoms or only mild symptoms. As the

disease gets worse, your symptoms usually become more severe. They
can include:

Frequent coughing or a cough that produces a lot mucus

Wheezing
A whistling or squeaky sound when you breathe
Shortness of breath, especially with physical activity
Tightness in your chest
Some people with chronic bronchitis get frequent respiratory infections
such as colds and the flu. In severe cases, chronic bronchitis can cause
weight loss, weakness in your lower muscles, and swelling in your
ankles, feet, or legs.

4.Treatment

There is no cure for chronic bronchitis. However, treatments can help

with symptoms, slow the progress of the disease, and improve your
ability to stay active. There are also treatments to prevent or treat
complications of the disease.
30
Treatments include:
Lifestyle changes, such as Quitting smoking if you are a smoker. This is
the most important step you can take to treat chronic bronchitis.
Avoiding secondhand smoke and places where you might breathe in
other lung irritants
Ask your health care provider for an eating plan that will meet your
nutritional needs. Also ask about how much physical activity you can do.
Physical activity can strengthen the muscles that help you breathe and
improve your overall wellness.
Medicines, such as
Bronchodilators, which relax the muscles around your airways. This
helps open your airways and makes breathing easier. Most
bronchodilators are taken through an inhaler. In more severe cases, the
inhaler may also contain steroids to reduce inflammation.
Vaccines for the flu and pneumococcal pneumonia, since people with
chronic bronchitis are at higher risk for serious problems from these
diseases.
Antibiotics if you get a bacterial or viral lung infection
Oxygen therapy, if you have severe chronic bronchitis and low levels of
oxygen in your blood. Oxygen therapy can help you breathe better. You
may need extra oxygen all the time or only at certain times.
Pulmonary rehabilitation, which is a program that helps improve the
well-being of people who have chronic breathing problems. It may
include
An exercise program
Disease management training
Nutritional counseling
Psychological counseling
A lung transplant, as a last resort for people who have severe symptoms
that have not gotten better with medicines
If you have chronic bronchitis, it's important to know when and where to
get help for your symptoms. You should get emergency care if you have
severe symptoms, such as trouble catching your breath or talking.
Calyour health care provider if your symptoms are getting worse or if
you have signs of an infection, such as fever.

31
 .

FIG: CHEST PHYSIOTHERAPY - CLAPPING

32
FIG: CHEST PHYSIOTHERAPY –VIBRATION

BRONCHIECTASIS TREATMENT

There is no cure for bronchiectasis because the damage to the

airways can’t be reversed, but its symptoms and lung infections
can be treated. The goal is to treat the underlying conditions
and lung infections, to remove mucus from the lungs, and to
prevent further complications.

Medicines prescribed for bronchiectasis treatment

Some of the medicines or treatments usually prescribed for
bronchiectasis are antibiotics, bronchodilators, expectorants,
and mucus-thinning drugs. In most cases, treatment involves a
combination of medication and the use of devices and exercises
tInfection treatment
Antibiotics are the most common treatment for lung infections,
which can be common in people with bronchiectasis. Some
33
people take continuous antibiotics because they get a lot of
infections. Antibiotics may be taken orally, or in case of more
difficult to treat infections, they may be given
intravenously.Oral antibiotics currently in use to treat acute
exacerbations of bronchiectasis in adults are amoxicillin, co-
amoxiclav, flucloxacillin, rifampicin, fucidin, and ciprofloxacin.

Intravenous antibiotics may be required in severe cases, or

where oral use fails to treat an acute exacerbation. IV
antibiotics currently in use for such cases are benzylpenicillin,
cefuroxime, ceftriaxone vancomycin, ceftazidime and
cefuroxime.

Long-term antibiotics are used in people with bronchiectasis to

improve disease symptoms, decrease exacerbation rates, and
improve quality of life. These include amoxicillin, flucloxacillin
and trimethoprim.

The choice of the adequate antibiotic will depend on the

specific bacteria that is causing the infection.Bronchodilators
for bronchiectasis
Bronchodilators relax the muscles around the airways. The
majority of the bronchodilators are inhaled medications, taken
using an inhaler or a nebulizer. They help to open the airways
so breathing is easier.

The bronchodilators commonly used for bronchiectasis

treatment include short-acting bronchodilators, such as
albuterol and levalbuterol, and long-acting bronchodilators,
such as formoterol, tiotropium and salmeterol.

Short-acting bronchodilators are used as a rescue medication

when there is a need for quick relief of shortness of breath, and
long-acting bronchodilators are used regularly to control
bronchiectasis symptoms.Other bronchiectasis treatments

34
Other bronchiectasis treatments include hydration, which turns
the mucus thinner and easier to cough up; chest physical
therapy (chest clapping or percussion) done by a therapist or
trained family member, using their hands or an external device,
to loosen mucus and help move it out of the lungs, or with an
external device, like therapy vest that uses high-frequency air
waves; oxygen therapy to raise low blood-oxygen levels; and
corticosteroids to treat airway inflammation.

Surgery may be considered if other treatments do not help and

only one part of the airway is affected, if symptoms aren’t
responding to other treatment or if major bleeding takes place.

Physiotherapy in bronchiectasis
Physiotherapy can be very useful in helping to manage the
mucus produced in bronchiectasis. A respiratory
physiotherapist will assess you in order to devise a personalised
management plan for you to perform at home.

Techniques used to help clear sputum may include:

Breathing exercises, such as the Active Cycle of Breathing

(ACBT)
Use of positioning to target the most affected portions of your
lungs which is known as postural drainage
Use of devices such as an Acapella, Aerobika or Flutter
You should do these techniques daily, even if you are feeling
well, to reduce the chances of mucus getting stuck, causing
further infections and leading to more damage. During an
infection, you may need to increase the amount of chest
physiotherapy that you do in order to control the clear the
larger quantities of sputum. A respiratory physiotherapist wil
be able to advise you on this based on your particular
presentation.

35
 MATERIALS

AND

METHODOLOGY

36
 METHODOLOGY

The study aims to establish the Immediate effects of active

cycle of breathing technique and postural drainage in patients
with bronchiectasis.

A total of 30 subjects ware screened and who fitted in to the

inclusion criteria given below were selected for study.
The subjects were explained about the study in the local
language and an informed consent was obtained.

RESEARCH SPECIFICATION:-

- Study design – Experimental design

- Study type – Comparative study
- Sample size – 30 subjects
- Sampling method – Convenient sampling
- Sampling specification – Group –A-15 subjects &
- Group –B-15 subjectsStudy setting – Department of
TUBERCULOSIS AND CHEST DISASES
Govt, Hospital, Mahabubnagar &
Navodaya Institute of Medical –Sciences, Mahabubnagar.
- Study duration – 2 months.

37
 -: CRITERIA SELECTION :-

INCLUSION CRITERIA:-
- Diagnosed cases of Bronchiectasis by chest physician (X-Ray,
CT, PFT)
- Age group 35 – 60years
- Both males and females
- Subjects with expectorated sputum quantity of 10ml - >
150ml/day
- Subjects with stable Hemodynamics
- Subjects under medications for bronchiectasis (antibiotics,
bronchodilators etc.,)

EXCLUSION CRITERIA:-
- Pulmonary hypertension
- Angina
- Pulmonary embolism
- Pneumothorax
- Pneumonia

38
 METHODOLOGY

The study aims to establish the Immediate effects of active

cycle of breathing technique and postural drainage in patients
with bronchiectasis.

A total of 30 subjects ware screened and who fitted in to the

inclusion criteria given below were selected for study.
The subjects were explained about the study in the local
language and an informed consent was obtained.

RESEARCH SPECIFICATION:-

- Study design – Experimental design

- Study type – Comparative study
- Sample size – 30 subjects
- Sampling method – Convenient sampling
- Sampling specification – Group –A-15 subjects &
Group –B-15 subjects
- Study setting – Department of TUBERCULOSIS AND CHEST
DISASES
Govt, Hospital, Mahabubnagar &
Navodaya Institute of Medical –Sciences, Mahabubnagar.
- Study duration – 2 months.

39
 -: CRITERIA SELECTION :-

INCLUSION CRITERIA:-
- Diagnosed cases of Bronchiectasis by chest physician (X-Ray,
CT, PFT)
- Age group 35 – 60years
- Both males and females
- Subjects with expectorated sputum quantity of 10ml - >
150ml/day
- Subjects with stable Hemodynamics
- Subjects under medications for bronchiectasis (antibiotics,
bronchodilators etc.,)

EXCLUSION CRITERIA:-
- Pulmonary hypertension
- Angina
- Pulmonary embolism
- Pneumothorax
- Pneumonia
- Diabetes mellitus
- Tuberculosis
- Bronchial asthma
- Any chest trauma
- Corpulmonale
- Recent abdominal surgery

40
TESTING PROCEDURE:-
Patient with bronchiectasis was chooses to establish the
immediate effects of active cycle of breathing technique and
conventional chest physiotherapy. After selecting the sample, test
procedure was explained to the subjects a written consent was
collected from the subjects and to participate in the study. The
time taken for discussion and for the determination of the
individuals pre-test measurements allowed for a period of rest
prior to testing. The 30 subjects who fitted into the inclusion
criteria were randomized into 2 groups A & B.

PRECAUTIONS:-
The subjects were asked to maintain the following precautions
- Avoid heavy meals within 2 hours of testing
- Wear comfortable clothing

PRE-TEST MEASUREMENTS:-
Peak expiratory flow rate in litors/second The peak
expiratory flow rate in liters/ sec was measured within the groups
(A, B & Both) subjects were randomly assigned to active cycle of
breathing Technique and conventional chest physiotherapy.
Exercises taught to Group – A subjects emphasized on active cycle
of breathing technique & Group-B – subjects were allocated to
conventional chest physiotherapy their effectiveness was
measured.

41
PROCEDURE FOR MEASURING PEAK EXPIRATORY FLOW
RATE:-
A mini-Wright’s peak flow meter was used. All the subjects
were encouraged to produce maximal effort and the procedure
was demonstrated. The meter was made to zero. Subjects were
asked to inhale completely quickly place the peak flow meter in to
the mouth and to make a seal around the mouthpiece with the
lips. Immediately then completely with maximal force. The
reading was taken as shown in the peak flow meter.

PROCEDURE FOR MEAURING EXPECTORATED SPUTUM:-

Any sputum produced during and following the treatment
was collected in to the mucus extractor and its volume measured
in milliliters.

42
 Group – A:-
Active cycle of Breathing Technique:-
Subjects were made to sit with back support and asked to
maintain a good breathing pattern with relaxed shoulders and
neck and breathe in through the nose and out through the mount
breathing out should be slow, like “sighing out”. This minimizes
anywheezing
* Breathing control:-
Rest one hand on abdomen keeping shoulders and upper
chest relaxed and allow their sound to rise gently as they breathe
in (if they imagine air filling the abdomen like abulloon this may
help) sigh out gently and ensure that the shoulders remain
relaxed over a few seconds gradually increase depth of breathing
while maintaining relaxation. Breathing control is an essential part
of the cycle to allow rest.
* DEEP BREATHING EXERCISES:
Take 3-4 deep breaths in allowing the lower chest to expand.
Try to ensure neck and shoulders remain relaxed. At the end of
the breath in hold the air in for 3 seconds. Let the air out gently.
* FORCED EXPIRATION TECHNIQUE / HUFF
“Huffs” are combined with breathing control and they were
asked to take a half breath in and blow air out steadily through an
open mouth. Follow this with breathing control as secretion
moves into larger air ways. Take a deep breath in and blow air out
again through an open mount. A typical cycle consists of:
Breathing control, 3 – 4 deep breaths, breathing control forced
expiration technique / huff. The total treatment session was 30
minutes.

43
 Group –B :-

Conventional chest physiotherapy:- All the 15 subjects in

the group B were allocated to conventional chest physiotherapy.
The conventional chest physiotherapy consists of postural
drainage, percussion, pressure-vibration active bilateral
respiratory exercises. The total treatment session was performed
under supervision and at the same time of the day. All usual
medications are to be administrated during the study days.

Post-test measurements:-
- Expectorated sputum in milliliters
- Peak expiratory flow rate in liters/second
For both the groups, peak expiratory flow rate was measured
using peak expiratory flow meter.
For both the groups, expectorated sputum was measured using
mucus extractor.
The collected data was used for statistical analysis.

44
 Relaxed Breathing

(15-30 seconds)

Chest Clapping
Relaxed Breathing + 2 Second Breath Hold
(15-30 seconds) -
Chest Shaking or Vibration
on Exhalation

3 or 4 Dee Breaths

Note: Return to the beginning 1-2 huffs if a

cough is elicited before the end the
cycle complete cycle 3-4 times.
1-2 Huffs

ACTIVE CYCLE OF BREATHING TECHNIQUE (ACBT)

Breathing hold

Thoracic mobility exercise

Clapping

Vibration

45
 STATISTICAL ANALYSIS

Statistical Methods:-

The independent variables are sputum & peak expiratory flow

rate. The statistical package graph pad prism was used for data
analysis.

The statistical tools used in this study are paired “t” test and
independent “t” test

Paired “t” test:-

Paired “t” test was used to find out the significant difference in
improvement between pre and post treatment values between
group-A and Group-B for sputum & peak expiratory flow rate.
Mean difference;-

Formulate t = ldl

S/ n √
d = ∑d/n
Where
d = x-y

Standard deviation:

S=

46
Where d is the calculated mean difference between pre treatment &
post treatment values
d- is the difference between pre treatment and post treatment values
s- is the standard deviation
n-sample size.

Student “t” test:-

The student independent “t” test is used to compare the
significant differences between group – A & Group – B for peak
expiratory flow rate.

47
Where
n1 = sample size in group A
n2 = sample size in group B
S12 = the square of standard deviation of group A
S22 = the square of standard deviation of group B
X1 = mean value of group A
X2 = mean value of group B
The calculated “t” value is compared with the standard table value.

MATERIAL & METHODOLOGY OF POSTAL DRINAGE

It was a randomized experimental study. The study included
a sample of 30 patients with age group between 30 to 60 years.
The subjects were diagnosed as bronchiectasis by pulmonologist
or physicians based on their clinical findings, irrespective of their
sex male and female. The diagnosed cases of bronchiectasis were
taken from “Navodaya Institute of Medical – Sciences.
Mahabubnagar”, “Govt., Chest & T.B. Hospital, Mahabubnagar”.
Telangana State.

INCLUSION CRITERIA:
Were diagnosed cased of isolated bronchiectasis age 30-60
years both males and females. Active hemorrhage with
hemodynamic recent spinal surgery & emphysema, bronco
pleural fistula, pulmonary edema. The subjects about the
treatment. The selected 30subjectw were two experimental
treatment groups i.e., Group – A and B 15 subjects in each group.

48
The active cycle of breathing technique for 15-20 minutes. Total
study period was hours ACBT was administered to the affected
lobe after explaining the procedure at postural drainage affected
lobes. The outcome tools used in the study pulmonary function
test.

FVC – Force Vital Capacity

FEV1 – Forced Expiratory volume in on second

PEFR – Peak Expiratory flow rate.

SPO2 - Pulse oxymetry was used to measure.

49
 Table -1

Mean, standard Deviation and standard error in pre and post test of
Active Cycle of Breathing Technique

Variable Pre-test Post-test

MEAN SD SE MEAN SD SE
FVC 2.61 1.41 0.36 3 1.53 0.39
FEV1 1.75 0.92 0.23 2.29 1.11 0.28
PEFR 4.87 0.81 0.21 5.63 0.94 0.24
SPO2 93.1 2.09 0.54 97.4 1.72 0.44

50
POSTURALDRAINAGE

51
POSTURAL DRAINAGE POSITIONS AND CHEST
PHYSIOTHERAPY
52
 DATA

ANALYSIS

53
 DATA ANALYSIS

TABLE 1

COMPARISON BETWEEN GROUP –A & GROUP – B

Test sputum volume

PEFR GROUP GROUP df CALCULATED TABLE P

VALUE VALUE VALUE

A B

Mean S.D. Mean S.D.

POST 3.73 1.486 6.00 1.512 28 4.141 1.701 0.9503

TREATMENT

There is no significant difference between the post-test peak expiratory

flow rate values between Group A & Group B (P<0.05)

54
 Graph – 1

A COMPARISON BETWEEN POST – TEST SPUTUM VOLUME IN

GROUP A AND B

5
ACBT
4 CPT

To number of subjects

55
 TABLE 2

Comparison of post test values of peak expiratory follow rate between

Group–A & B

PEFR GROUP GROUP df CALCULATED TABLE P

VALUE VALUE VALUE
A B
Mean S.D. Mean S.D.
POST 210.06 63.7 288 49.01 28 0.834 1.701 0.410
TREATMENT

PETER Peak
Expiratory Flow Rate
There is no significant difference between the post-test peak expiratory
flow rate values between Group –A & B (P>0.05)

56
 GRAPH-2

COMPARISON BETWEEN GROUP-A AND GROUP-B

4 Group - A
Group-B
3

0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Total number of subjects

57
RESULTS

58
 RESULTS

The purpose of the study was to compare the immediate

effects of active cycle of breathing technique and postural drainage
in patients with bronchiectesis were analyzed by using paired “t”
test.

The each group on the basis of improvement were compared

using unrelated paired “t” test tube 1, 2, 3, & 4 difference in

- FVC was 0.18 with T value being 4.52 with P< 0.05

- FEVI the mean difference is 0.266 and “t” value 4.47 with P<
0.05

- PEFR the mean difference is 0.34 and “t” value 3.45 with P<
0.05

- The airways in bronchiectesis. When compared to postural

drainage. But when compared with other variables of pulmonary
function test for the improvement PEFR – shows less significant
improvement as p value is 0.002

- SPO2 difference 2.2 & T value 5.38 with P< 0.05

The active cycle of breathing technique having very high

significance in clearing the airways in bronchiectesis when compared
to postural drainage.

59
DISCUSSION

60
 DISCUSSION

The comparative study between effectiveness of active cycle

of breathing technique and postural drainage for improving
pulmonary function in bronchiectesis patients. The result of the
study supports the hypothesis that there will be a significant
effect in airway clearance through arterial blood gas analysis.
These statements were proved right again in this study by
compassing the pre and post ACBT intervention difference with
P<0.05 in FVC, FEV1, PEFR and SPO2. The first time after a gap of 8-
10 hours of previous treatment session.

There are significant changes seen in FVC, PEFR and FEVI in

this study after the intervention at both ‘ACBT’ and postural
drainage in bronchiectesis and this findings were supported by
J.A.Pryor maximum expiratory flow rate 25% and 50% of FVC,
following the instigation of the ACBT.

The Vincent mysliwiec et al their study stated that bronchiectesis

caused by infecting tends to occur predominantly in middle-aged to
elderly populations defects is likely to occur in younger patients. This
study was very well hold up with the above statement as major city 97%
of the population. 35 years of age group. The age range with the highest
frequency of bronchiectesis was 60 to 80 years.

61
CONCLUSION

62
 CONCLUSION

The results of this study active cycle of breathing technique

and postural drainage in patients with bronchiectesis – found to

have significant effect in clearing the airways the active cycle of

breathing technique has abettor effect them postural drainage.

Improving good pulmonary function in patients with

bronchiectesis.

Thus, this study will be useful for selection of intervention

in subjects postural drainage in patient bronchiectesis.

63
 LIMITATIONS

&

RECOMMENDATIONS

64
 LIMITATIONS:-

-Some of the subjects cannot perform the postural drainage –

breathing techniques property.

-The sample size is small.

Further recommendations:-
-The test of both male and female subjects can be done.

-Quality of life can be assessed

-The comfort, choice of the patient for the treatment selection

can be assessed

- Long term effects can be studied

-Effects in severe cases of postural drainage bronchiectesis can

-be studied

65
BIBILOGRAPHY

66
 BIBILOGRAPHY

1. Singleton R. Morris A, Redding G, Bronchiectasis in Alaska

Native children.

2. Stuart B.Porter. Tidys physiotherapy 13thEdition 2005, Elsevier

page no.310.

3. Will E. Hammon and Scott M.Hasson principles and practice of

cardio pulmonary physical therapy. Donna Frownfelter &
Elizabeth Denna 3rd Edition.1996 Page No. 80-82 & 520-521

4. A.P.I. Text book of medicine 6th Edition 1999, Association of

physicians of India, Mumbai, Page No. 236-237

5. Reid L.M.Reductionin bronchial subdivision in bronchiectasis.

Thorax 1950; 5:233-247
6. Nicotra MB, Rivera M, Dale AM, Shepherd R, Carter R.Clinical,
pathophysiologic, and microbiologic characterization of
bronchiectasis in an again cohort, Chest 995;108:955-961

7. Hansell DM. Bronchiectasis.Radiol Clin North Am 1998;

36:107-128

8. E Silverman et al. Current management of bronchiectasis:

review and 3acre studies, Heart Lung. 2003 Mar-Apr; 32(2):110.

9. Pryor JA Physiotherapy for airway clearance in adults. Eur

Respir J 1999;14:1418-1424

10.SW Clarke, Rationale of airway clearance, Eur Respir J

Suppl.1989 Jul;7:599s-603s

11.Christensen EF, Nedergaard T, Dahl R. Long-term treatment of

chronic bronchitis with positive expiratory pressure mask and
chest physiotherapy. Chest 1990;97: 645-650

67
12.JE Paterson, JM Bradley, JS Elborn, Airway clearance in
bronchiectasis: a randomized crossover trial of active cycle of
breathing techniques (incorporating postural drainage and
vibration) versus test of incremental respiratory endurance.
Chiron Respire Dis. 2004; 1(3):123-4.

13.13.JE Patterson et al. Airway clearance in bronchiectasis:

arandomized crossover trial of active cycle of breathing
techniques versus Acapella. Respiration. 2005 May-June: 72(3):
239-42.

14.Denehy L. A randomized controlled trial comparing periodic

mask CPAP with physiotherapy after abdominal surgery.
Physiother Res Int.2001; 6(4):236-50.

15.Pryor JA, Webber BA, Hodson ME.Effect of chest

physiotherapy on oxygen saturation in patients with cystic
fibrosis. Thorax 1990; 45:77.

16.Savic S, Ince DI, Arikan H.A comparison of autogenic drainage

and the active cycle of breathing techniques in patients with
chronic obstructive pulmonary diseased. J Cardiopulm Rehabil.
2000 Jan-Feb;20(1):37-43.

17.Pryor JA, Webber BA.An evaluation of the forced expiration

technique as an adjunct to postural drainage. Physiotherapy
1979; 65:304-307.

18.Cecins NM, Jenkins SC, Pengelley J, Ryan G, The active cycle of

breathing techniques to tip or not to tip: Respir Med.1999 Sep;
93(9):660-5.

19.C S Tompson, S Harrision, J Ashley, K Day and D L Smith

Randomised crossover study of the flutter device and the active
cycle of breathing technique in non-cystic fibrosis bronchiectasis
Thorax 2002;57:446-448© 2002 Thoras.

20.Baseler F, Wilde J, Pielesch W, Postural drainage and

breathing gymnastics – conditions sine qua non-before lung

68
resctions for bronchiectasis(author’s transal), Z Erkr
Atmungsorgane.1977 Mar;147(3):258-63.

Vincent Mysliwiec, MD; Joseph S.Pina, in their article bronchiectasis:

the ‘other’ obstructive lung disease, MD vol 106/no 1/ July 1999/
Postgraduate Medicine.

69
ANNEXURE

70
 ANNEXURE-I

-: CONSENT FROM:-

I___________________FREELY AND VOLUNTARILY AGREE TO

PARTICIPATE IN THE STUDY CONDUCTED ON A STUDY ON

“EFFICACY OF ACTIVE CYCLE OF BREATHING TECHNIQUE AND

POSTURAL DRAINAGE IN PATIENTS WITH BRONCHITECTASIS – A

COMPARATIVE STUDY”

I was explained in detail about the procedure of the study and I

understood the requirements and benefits of the study.

I solely give consent to participate in the study.

Date:
Signature.
Participant.

71
 ANNEXURE –II

ASSESSMENT CHART
ACTIVE CYCLE OF BREATHING TECHNIQUE POSTURAL DRAINAGE IN
PATIENTS BRONCHIECTASIS
PATIENT PROFILE:-
Name ::
Age ::
Sex ::
I.P.No. ::
Date ::
Occupation ::
Address ::
Past history ::
Present history ::
Medical history ::
Chief complaints ::
Pain-assess ::
Right & left ::
Back Right & left ::
Vital sings ::
B.P. ::
RR ::
HR ::
Temp ::
Radiological finding ::
X-Ray ::
CT – Scan ::
ECG and 2D ECO ::
Lab finding ::
Test for blood ::
CBP ::
CRP ::
ESR ::
ABG ::
PT Management ::

72
MEASUREMENT
TOOL

73
MEASURMENT TOOL
Spirometry may give some help in establishing the level
of morbidity associated with bronchiectasis at diagnosis
but is also a useful tool to assess disease progression
and the effect of interventive therapies.

74
75
FIG: LUNG FUNCTION MONITORING WITH
SPIROMETRY

76
77
CASE STUDY

78
 CASE STUDY
PATIENT PROFILE:
NAME : LAXMI
AGE : 68 YEARS
SEX : FEMALE
OCCUPATION :
Past history : Shotness of breath , Hypoxemia
Present history : Wheezing , Crackles , Sinusitis , Wet
Cough , Hemoptysis , Purulent sputum.
Personal history :
Smoking – No
Drugs - No
Alcholism - No

OBJECTIVE ASSESSMENT :
Vital signs : Low
Heart rate : high Systolic bp
Resporatory rate : >25 beats/min

79
Breathing pattern : Hyper ventilation & upper chest
Breathing
Thoraco abdominal
Peripheral level - Filled with mucus
Edema - yes
Cludding - Yes

On Palpation :
Tenderness : Yes
Chest wall excursion :
Upper lobe movement - Normal
Middle lobe movement - Effected
Lower lobe movement - Adnormal
Tactile fremiots - Densed
Trancheal deviation - Yes
On Percussion :
Resonant - replaced
Dull - Densed
Hyper resonant - Pulmonary hyper expansion
Flat - No
Diophragm - Elevated

80
On Ascultion :
- Chest Sounds
- Breathing Sounds
Normal- No
Abnormal - Yes
- Voice sound
Egophonic - No
Bronchio phonic - Yes
Heart Sound :
Aortic Sounds - Normal
Pulmonary area - Normal
Tricuspid area - Abnormal
Mitral area - Abnormal

On Exmination :
Chest wall measurement - Pleurtic
Evalution of breath - High CT
Musclr strenghr - Poor
Range of motions - Decreases
Pain assessment - Severe

81
Pulmonary function test - Low
Exercise tolerence test - Low

Radio logical Finding :

X- Ray - Filled with purulent sputum
CT - Scan - Bronchial dilation
ECG - Tachycardia
PT Management :
- Postural drainage
- Chest physiotherapy

82