Postural drainage

With postural drainage, you get into a position that helps drain fluid out of the lungs. It may help:

• Treat or prevent an infection
• Make breathing easier
• Prevent more problems with the lungs

A respiratory therapist, nurse, or provider will show you the best position for postural drainage.

The best time to do postural drainage is either before a meal or an hour and a half after a meal, when your stomach is emptiest.

Use one of the following positions:

• Sitting
• Lying on your back, stomach, or side
• Sitting or lying with your head flat, up, or down

Stay in the position for as long as your provider instructed (at least 5 minutes). Wear comfortable clothes and use pillows to get as comfortable as possible. Repeat the position as often as instructed.

Breathe in slowly through your nose, and then out through your mouth. Breathing out should take about twice as long as breathing in.

Your provider may also recommend doing percussion or vibration.

Percussion helps break up thick fluids in your lungs. Either you or someone else claps a hand on your ribs while you are lying down. You can do this with or without clothing on your chest:

• Form a cup shape with your hand and wrist.
• Clap your hand and wrist against your chest (or have someone clap your back, if your provider tells you to).
• You should hear a hollow or popping sound, not a slapping sound.
• Do not clap so hard that it hurts.

Vibration is like percussion, but with a flat hand that gently shakes your ribs.

• Take a deep breath, then blow out hard.
• With a flat hand, gently shake your ribs.
• You may use a specially designed vest to provide the vibration.

Your provider will show you how to do this the right way.

Do percussion or vibration for 5 to 7 minutes in each area of the chest. Do this on all of the areas of your chest or back that your provider tells you to. When you finish, take a deep breath and cough. This helps bring up any phlegm, which you can then spit out.

Contact your provider if you have:

• Indigestion
• Vomiting
• Pain
• Severe discomfort
• Difficulty breathing

Chest physical therapy; CPT; COPD - postural drainage; Cystic fibrosis - postural drainage; Bronchopulmonary dysplasia - postural drainage

Mort TC, Keck JP Jr, Subramanya S, Palaniappan D, Sharofi S. The endotracheal tube and respiratory therapy. In: Hagberg CA, Artime CA, Aziz MF, eds. Hagberg and Benumof's Airway Management. 5th ed. Philadelphia, PA: Elsevier; 2023:chap 44.

Netter FH. Therapies and therapeutic procedures. In: Netter FH, ed. Netter Collection of Medical Illustrations: Respiratory System. 3rd ed. Philadelphia, PA: Elsevier; 2025:chap 5.

Rochester CL, Nici L. Pulmonary rehabilitation. In: Broaddus VC, Ernst JD, King TE, et al, eds. Murray and Nadel's Textbook of Respiratory Medicine. 7th ed. Philadelphia, PA: Elsevier; 2022:chap 139.

Updated by: Charles I. Schwartz, MD, FAAP, Clinical Assistant Professor of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, General Pediatrician at PennCare for Kids, Phoenixville, PA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.