Can lung and breathing exercises help patients with pleural effusions?

Lung and Breathing Exercises for Pleural Effusions

Breathing exercises and physiotherapy can significantly improve lung function and reduce hospital stay in patients with pleural effusions when added to standard drainage treatment, but they do not replace the need for definitive management of the underlying effusion. 1

Evidence for Physiotherapy Benefits

The strongest evidence comes from a randomized controlled trial demonstrating that a structured physiotherapy program (deep breathing exercises, mobilizations, and incentive spirometry) added to standard drainage treatment produces measurable improvements in patients with pleural effusions 1:

• Forced expiratory volume improved from 72.13% to 78.98% of predicted values (p<0.001) in the physiotherapy group versus no significant change in controls 1
• Vital capacity showed significant improvement (73.1% to 72.13% predicted, p<0.001) compared to standard treatment alone 1
• Radiographic findings demonstrated better resolution on the affected side at discharge 1
• Hospital length of stay was reduced by 12 days (26.7 days versus 38.6 days, p=0.014) 1

Critical Limitation: Exercises Are Adjunctive Only

Breathing exercises cannot drain fluid or address the underlying cause of pleural effusion. The primary management must focus on:

For Symptomatic Effusions

• Drainage is the cornerstone of treatment - either through thoracentesis, chest tube, or indwelling pleural catheter (IPC) depending on the clinical scenario 2, 3
• Controlled drainage technique is essential - limit removal to 1-1.5L at one time to prevent re-expansion pulmonary edema 2, 3

For Asymptomatic Effusions

• No therapeutic intervention should be performed - observation alone is recommended 4, 3

When Breathing Exercises Are Most Beneficial

Physiotherapy should be implemented as an adjunct to drainage in the following scenarios:

• After successful drainage to optimize lung re-expansion and prevent atelectasis 1
• In patients with expandable lung where exercises can facilitate pleural apposition 2
• During recovery phase to restore respiratory muscle function and improve ventilatory mechanics 1

Common Pitfall to Avoid

Never rely on breathing exercises alone to manage symptomatic pleural effusions. The fluid must be drained first, as exercises cannot overcome the mechanical restriction imposed by fluid accumulation 2, 3. In malignant pleural effusions specifically, definitive management with either chemical pleurodesis or IPC is required after initial drainage to prevent recurrence 4, 3.

Clinical Algorithm

1. Assess symptoms: If dyspneic, proceed with drainage; if asymptomatic, observe 4, 3
2. Perform controlled drainage: Limit to 1-1.5L initially 2, 3
3. Assess lung re-expansion: Post-drainage imaging determines next steps 2
4. Initiate physiotherapy program: Deep breathing exercises, incentive spirometry, and mobilization once drainage is established 1
5. Definitive management: Based on etiology (pleurodesis for malignant effusions with expandable lung, IPC for trapped lung) 4, 3

The physiotherapy component specifically improves spirometric parameters and accelerates recovery, but only when combined with appropriate fluid management 1.