Old and new in chest physiotherapy.

Some "old" chest physiotherapy techniques, such as postural drainage of bronchial secretions, breathing control, relaxation, pre- and post-surgical treatments and exercise training have survived until today because of their unquestionable and persistent validity. This does not mean that in this field of rehabilitation medicine nothing new exists. Chest physiotherapy has now completely overcome the empirical phase that characterized every branch of medicine during its early development. We now employ mainly respiratory pathophysiology techniques for objective evaluation of physiotherapy efficacy. For example we use transcutaneous monitoring of blood gas variations during therapy. Among new chest physiotherapy techniques, biofeedback training may lead to better relaxation in a shorter time, and it is now widely used in breathing control. Jet-ventilation and percussion-ventilation seem likely to mark a further improvement in bronchial secretion drainage. Concerning the future of chest physiotherapy, the recent advances in the physiology and pathophysiology of respiratory muscles are disclosing important practical implications, e.g. in defining criteria for respiratory muscle training and rest in chronic respiratory failure.