Breathing techniques - thoracic expansion

Question 1

Rationale behind thoracic expansion

Answer 1

Air can move behind
Secretions and helps mobilise them

Helps treat breathlessness, expel sputum and increases lung capacity

Question 2

Physiological effects of thoracic expansion

Answer 2

Thoracic expansion allows interalveolar channels to be accessed more effectively
Air can move behind secretions and helps mobilise them
Encourages reinflation of collapsed alveoli

Question 3

What structures are effected by thoracic expansion?

Answer 3

1. Pores of Kohn – an opening between an alveoli and its neighbour
2. Canals of Lambert – link between alveoli and respiratory bronchiole
3. Channels of Martin – communication between two respiratory bronchioles

Question 4

How would you treat a patient using thoracic expansion?

Answer 4

1. Introduce yourself
2. Explain purpose of the treatment and
   check contraindications
   3.Gain informed consent
3. Ensure environment is suitable and position patient appropriately using pillows and provide towel/blanket for comfort as required
4. Place the palm in the mid-axillary line over approximately the 7/8th ribs; relaxed fingers covering the posterior aspect of the thorax.
5. Instruct the patient to relax and breathe out, allowing the lower ribs to sink down and in - not forced.
6. At the end of expiration, apply mild pressure to the chest wall & instruct the patient on the next inspiration to expand the lower ribs against your hand (provides feedback).
7. Pressure should be released at the end of inspiration and re-applied when the patient is ready to breathe in again
8. Monitor patient carefully throughout for any adverse reactions E.g. lightheadedness or dizziness and check they are comfortable
9. Re-assess patient and check for any adverse effects

Question 5

Contraindications/precautions?

Answer 5

Patients unable to participate – although not a true contraindication, breathing exercises require an
element of patient participation and understanding

Inadequate pain control
Acute bronchospasm
Acute, unstable head, neck or spinal surgery
Acute medically unwell/instability

Are you feeling well in yourself?
Any abnormal breathing recently?
Any hreart/lung conditions?
Recent head/neck/spine surgery?

Question 6

How would you document this?

Answer 6

Date, Time, Patient name
Explanation of procedure & gaining informed consent
Amount of thoracic expansions completed
Patient feedback - fatigue quickly? Able to resist pressure? Adverse effects?
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