Chest Tapping: Technique, Benefits, and Precautions for Airway Clearance

How to do chest tapping?

Chest tapping, also known as chest percussion or manual chest physiotherapy, is a technique used primarily in respiratory care to help loosen and mobilize mucus and secretions from the lungs, facilitating their clearance from the airways.

What is Chest Tapping?

Chest tapping is a component of airway clearance techniques (ACTs) used to manage various respiratory conditions characterized by excessive mucus production or impaired mucus clearance. It involves rhythmically striking the chest wall with cupped hands over specific lung segments. The goal is to create vibrations that dislodge tenacious secretions adhering to the bronchial walls, making them easier to cough up. This technique is often performed in conjunction with postural drainage, where the individual is positioned to allow gravity to assist in draining secretions from the lungs.

Who Can Benefit from Chest Tapping?

Chest tapping is typically prescribed by healthcare professionals for individuals with conditions that lead to chronic mucus buildup in the lungs. These include, but are not limited to:

• Cystic Fibrosis (CF): A genetic disorder causing thick, sticky mucus.
• Bronchiectasis: A condition where the airways become abnormally widened, leading to mucus accumulation.
• Chronic Obstructive Pulmonary Disease (COPD): Particularly during exacerbations with increased sputum production.
• Pneumonia: To aid in the clearance of inflammatory exudates.
• Asthma: In cases of severe mucus plugging.
• Post-operative patients: To prevent atelectasis (lung collapse) and pneumonia, especially after chest or abdominal surgery.

It is crucial that this technique is performed under the guidance or instruction of a qualified healthcare professional, such as a physical therapist, respiratory therapist, or nurse.

How to Perform Chest Tapping

Chest tapping can be performed by a caregiver (assisted tapping) or, less commonly, by the individual themselves (self-tapping) on accessible areas. The technique requires precision and proper hand positioning to be effective and safe.

Preparation

• Consult a Professional: Always receive instruction from a healthcare professional before attempting chest tapping. They will identify the specific lung segments to target based on your condition.
• Comfortable Positioning: The individual should be in a comfortable position that allows access to the chest and back. This often involves various postural drainage positions (e.g., lying on the side, stomach, or back with pillows to elevate certain body parts) to target specific lung lobes.
• Clothing: Ensure the individual is wearing light clothing or a thin towel over the skin. Direct skin tapping can be uncomfortable or irritating.
• Hand Shape: The most critical aspect is the hand shape. Form a cupped hand (like scooping water) with fingers and thumb adducted. The hand should be hollow, trapping air as it strikes the chest, producing a distinctive "hollow" sound rather than a flat slap. This cupped shape creates a cushion of air, making the percussion more effective and less painful.

Technique

1. Target Area Identification: The healthcare professional will indicate the precise areas of the chest wall corresponding to the affected lung segments.
2. Rhythm and Force: Using the cupped hand, rhythmically tap the chest wall. The motion should come from the wrist and elbow, not the shoulder.
   • Rate: Aim for a steady, rhythmic tapping at a rate of 100-120 beats per minute (similar to a brisk walk).
   • Force: The force should be firm enough to create vibrations within the chest, but not so hard as to cause pain or bruising. It should be comfortable and tolerable for the individual.
3. Duration: Each targeted lung segment is typically percussed for 3-5 minutes. The entire session, involving multiple segments and postural drainage positions, can last from 20-40 minutes.
4. Breathing: Encourage the individual to breathe slowly and deeply during the tapping.
5. Coughing: After percussing a segment, encourage the individual to take a few deep breaths and then cough forcefully to clear any loosened secretions. A "huff cough" (a forced exhalation with an open glottis) is often more effective than a traditional cough for moving mucus.

Self-Tapping vs. Assisted Tapping

Assisted tapping is generally preferred and more effective because a caregiver can reach all lung segments, including those on the back, and apply consistent, correct technique.

Self-tapping is possible for accessible areas (e.g., upper chest, collarbone area) but is less comprehensive. It might be used as a supplementary technique or when no caregiver is available, but it cannot replace full assisted chest physiotherapy for comprehensive airway clearance.

Potential Benefits of Chest Tapping

The primary benefit of chest tapping is improved airway clearance, leading to:

• Reduced Mucus Buildup: Helps prevent the accumulation of thick secretions, which can block airways.
• Improved Breathing: Clearer airways lead to easier and more efficient breathing.
• Decreased Risk of Infections: By removing stagnant mucus, the technique reduces the breeding ground for bacteria, lowering the incidence of respiratory infections like pneumonia.
• Enhanced Lung Function: Maintaining clear airways helps preserve lung capacity and overall pulmonary health.
• Reduced Hospitalizations: Regular and effective airway clearance can decrease the frequency and severity of exacerbations, leading to fewer hospital admissions.

Important Precautions and Contraindications

Chest tapping is not suitable for everyone and has several contraindications. Always consult a healthcare professional before initiating this therapy.

Absolute Contraindications (Do NOT perform):

• Acute Asthma Attack or Bronchospasm: Tapping can worsen airway constriction.
• Hemoptysis (Coughing up Blood): Can exacerbate bleeding.
• Unstable Angina or Recent Myocardial Infarction: Increased stress on the cardiovascular system.
• Pulmonary Embolism: Risk of dislodging the clot.
• Untreated Pneumothorax (Collapsed Lung): Can worsen the collapse.
• Severe Osteoporosis or Rib Fractures: Risk of further injury.
• Spinal Fusion or Unstable Spine: Risk of injury.
• Head or Neck Injury (until stabilized): Risk of worsening injury.

Relative Contraindications (Use with extreme caution and professional guidance):

• Recent Surgery (especially chest or abdominal): Pain, wound dehiscence.
• Skin Lesions, Burns, or Open Wounds: Avoid direct contact.
• Subcutaneous Emphysema: Air trapped under the skin.
• Tuberculosis: Risk of spreading infection (though less common with proper precautions).
• Coagulation Disorders or Anticoagulant Therapy: Increased risk of bruising or bleeding.
• Pain: If the individual experiences pain, stop immediately.

Integrating Chest Tapping into Your Routine

For individuals with chronic respiratory conditions, chest tapping is often part of a daily routine. The frequency and duration will be determined by a healthcare provider based on the individual's condition, mucus production, and response to therapy. It is typically performed:

• Before Meals: To avoid nausea or vomiting from coughing.
• Before Bed: To clear airways for better sleep.
• Upon Waking: To clear secretions accumulated overnight.
• During Exacerbations: More frequently during periods of increased mucus.

Chest tapping is often combined with other airway clearance techniques, such as:

• Postural Drainage: Specific body positions to use gravity for mucus drainage.
• Huff Coughing: A controlled breathing technique to move mucus without excessive strain.
• Positive Expiratory Pressure (PEP) Devices: Devices that provide resistance during exhalation to open airways and move mucus.
• Oscillatory PEP Devices (e.g., Flutter valve, Acapella): Devices that combine PEP with vibrations.
• Inhaled Bronchodilators or Mucolytics: Medications to open airways or thin mucus, often administered before ACTs.

When to Consult a Healthcare Professional

Always consult a doctor or respiratory therapist if you experience:

• Increased shortness of breath or difficulty breathing.
• Changes in the color, consistency, or amount of sputum.
• Fever or chills.
• Chest pain during or after tapping.
• Coughing up blood.
• Any new or worsening symptoms.

Chest tapping is a powerful tool in respiratory management, but its proper application under professional guidance is paramount for safety and efficacy.