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Aspects of lung expansion in relation to pulmonary physiotherapy.

Different procedures used in pulmonary physiotherapy that may affect lung expansion are reviewed. Distribution of regional lung volumes is dependent on body position and total lung volume. By increasing functional residual capacity, more airways may open and thus airway closure may be avoided. Ventilation distribution is flow dependent, which must be evaluated further in assessing different breathing patterns. Different breathing patterns, such as diaphragmatic and basal-costal breathing, involve changes in shape of the chest wall; however, no systematic effects on ventilation distribution have been demonstrated, although according to theoretic analyses and animal experiments the local distending pressures may be dependent on local shape changes. Instructions on such breathing types may therefore be given to achieve a “relaxed” breathing pattern or to maintain rib cage and diaphragm mobility, but not to alter ventilation distribution.