Postural Drainage

What is postural drainage?

Postural drainage is the use of body positions to help clear mucus out of your lungs. Respiratory therapists use postural drainage positions with other chest physiotherapy (chest PT) techniques to help people with certain lung conditions breathe better. This is sometimes called postural drainage and percussion (PD&P).

If it weren’t for tiny hairs in your lungs (cilia), mucus would settle in your lungs and stay there, thanks to gravity. Cilia push mucus upward until you cough it out of your airways. But some conditions, like cystic fibrosis and COPD, make mucus hard to clear. Postural drainage positions your body so gravity is working in your favor and your body doesn’t have to work as hard to clear mucus.

There are several postural drainage positions, and each is meant to clear a different part of your lungs. You might lie on your belly, side or back, or sit up. Many positions use pillows or wedges for support. Your healthcare provider will give you instructions on which positions will be safe and work best for you.

What conditions is postural drainage used for?

Healthcare providers might recommend postural drainage as part of management of:

• Cystic fibrosis
• COPD (chronic obstructive pulmonary disease)
• Bronchiectasis
• Pneumonia
• Neuromuscular disorders
• Atelectasis

How do I prepare for postural drainage?

It’s best to do postural drainage on an empty stomach (or 90 minutes after eating). Your provider may also suggest you use a bronchodilator 15 to 30 minutes before postural drainage. Ask your provider if there are any specific instructions you should follow to prepare. Be sure to let them know about any health conditions, including bleeding or blood pressure issues, before performing postural drainage.

What happens during postural drainage?

During postural drainage:

1. You’ll get into position to drain certain parts of your lungs. This could be on your side, belly or back, or sitting up. You might have a pillow or wedge for support.
2. Your provider will perform percussion/clapping or vibration on your chest or back to loosen mucus. They may give you instructions, like when to inhale and exhale.
3. You’ll cough out any mucus.
4. Your provider might have you change position and start the process again, to clear mucus from different parts of your lungs.

Can you do postural drainage on yourself?

For some conditions, a respiratory therapist may recommend certain postural drainage positions that you can do yourself. They might have you use a percussion vest, an airway clearance (PEP) device or breathing techniques to help clear the mucus in each position. It’s best to only use these techniques if a healthcare provider has recommended them and shown you how to safely perform them by yourself.

How effective is postural drainage?

It’s hard to measure the effectiveness of postural drainage compared to other airway clearance techniques. Many factors contribute to how effective treatments are, including how easy it is for people to stick to them. Your provider can let you know the pros and cons of various treatments based on your specific situation.

What are the risks of postural drainage?

Risks of postural drainage include:

• Shortness of breath
• Vomiting
• Aspiration (when something other than air gets into your airways)
• Hypoxia
• Low blood pressure
• Bleeding in your lungs
• Increased intracranial pressure (the pressure inside your head)
• Bronchospasm
• Abnormal heart rate
• Rib, spine or muscle injury

Using only head-up positions (rather than having your head tilted toward the ground) reduces your risk of these complications.

Additionally, sometimes postural drainage can feel uncomfortable. Let your provider know about any discomfort you have in the process.

Who’s at higher risk for complications of postural drainage?

You might be at higher risk for complications if you have:

• A recent rib or spine injury
• Severe osteoporosis
• Bleeding (for instance, if you’ve been coughing up blood) or high risk of bleeding
• Health conditions affecting your blood pressure

You should always talk to your provider about any medical conditions you have to make sure it’s safe to be in postural drainage positions.

When should I call my healthcare provider?

If you experience any of these symptoms, let your provider know right away (if you’re with them) or call 911 or emergency services:

• Difficulty breathing
• Coughing up blood
• Chest pain
• Severe headache
• Weakness
• Dizziness
• Bluish skin, lips or nails (cyanosis)