Postural Drainage Technique for Retained Secretions

Core Positioning Technique

The American Thoracic Society recommends postural drainage uses gravity-assisted positioning with head-down tilt to drain the lower and middle lung lobes, and is most effective when combined with percussion and coughing for 20-minute sessions performed twice consecutively 1, 2
Head-down tilt positions are the standard approach for postural drainage, as recommended by the British Thoracic Society 1, 2

The European Respiratory Society suggests that combining postural drainage with percussion and coughing clears significantly more sputum at 60 and 90 minutes compared to other techniques 1, 2, 3
Two consecutive 20-minute sessions of postural drainage with percussion and coughing are required for cumulative effect, particularly for clearing viscous secretions with poor rheological properties, as recommended by the American College of Chest Physicians 1, 2, 3

The Cystic Fibrosis Foundation recommends combining postural drainage with huffing or forced expiratory technique as an adjunct for patients with cystic fibrosis and bronchiectasis 4, 5, 6
Autogenic drainage can substitute for patients who cannot tolerate head-down positions, though it clears mucus faster but without spirometry differences, as suggested by the European Cystic Fibrosis Society 4, 5, 6

The Global Initiative for Chronic Obstructive Lung Disease recommends that huffing should replace vigorous coughing to minimize airway collapse in COPD patients 4, 6, 7
The American Thoracic Society advises against manually assisted cough as it decreases peak expiratory flow by 144 L/min and may be detrimental in COPD patients 4, 7

The British Thoracic Society notes that gastroesophageal reflux disease (GORD) is a theoretical concern with head-down positions, though no studies confirm increased reflux in bronchiectasis patients 1, 2, 8, 9
Modified postural drainage (without head-down tilt) can be used when GORD or breathlessness is problematic, though effectiveness compared to traditional PD is unproven, as suggested by the European Respiratory Society 8, 9, 3

The American College of Chest Physicians recommends 20-minute sessions performed twice consecutively for maximum viscous secretion clearance 1, 2, 3

The American Thoracic Society suggests that manual techniques (percussion, vibration, shaking) should only be used during active postural drainage sessions, not independently, as evidence does not support their standalone use 1, 2, 3

The European Respiratory Society notes that single 20-minute session may not clear viscous secretions; two consecutive sessions are needed 1, 2, 3
The Global Initiative for Chronic Obstructive Lung Disease advises against applying manually assisted cough in COPD as it can worsen outcomes 4, 7

The British Thoracic Society recommends reviewing CT imaging to identify affected bronchopulmonary segments and teaching appropriate postural drainage positions for specific segments 10

The American College of Chest Physicians recommends postural drainage as an effective technique to increase mucus clearance in cystic fibrosis patients 11

The European Respiratory Society suggests monitoring sputum volume, radioaerosol clearance, and patient tolerance to assess the effectiveness of postural drainage 12
The American Thoracic Society recommends monitoring the correlation between tracheobronchial clearance and radioactivity content in sputum (rs² = 0.76) and number of coughs (rs² = 0.65) to assess the effectiveness of postural drainage 13

The British Thoracic Society suggests considering alternative techniques such as autogenic drainage, positive expiratory pressure, high frequency chest wall oscillation, or intrapulmonary percussive ventilation if postural drainage is not effective or acceptable 10
The American College of Chest Physicians recommends active cycle of breathing techniques (ACBT) plus postural drainage to enhance sputum expectoration compared to ACBT in sitting position alone 10
The European Respiratory Society notes that postural drainage is time-consuming, may require caregiver assistance, and has limited long-term outcome data for quality of life, exacerbation rates, or mortality [11] [12] 13