Percussion of the Thorax in Dogs

Percussion of the thorax, known as coupage, is a physiotherapy technique which helps dogs with a buildup of mucus and secretions in the lung to breathe more easily. It is used as an adjunctive therapy with treatments such as nebulized drugs, antibiotics and anti-inflammatory medications, and where necessary, an oxygen enriched environment.

It's important the patient is first assessed by a qualified veterinary physiotherapist. The latter will advise the owner of the appropriate technique for that particular dog. Once the correct regime is established, coupage can be carried out regularly at home by the owner.

The frequency of coupage therapy depends on the underlying condition. Typically a dog with an acute chest infection may require coupage every one to two hours, whilst in less severe cases coupage four to five times a day is sufficient. 

The term 'coupage' is derived from a French term meaning 'cupping'. This refers to the way the hand is gently cupped so that a small air pocket sits in the palm of the hand. Two cupped hands are alternately struck against the chest wall in a rhythmic way to mimic the sound of a galloping horse. The operator either focuses on one area of the lungs where there's a known problem, or for more general breathing difficulties, covers the entirety of both sides of the chest 

The force should be firm yet not heavy enough to cause discomfort. For small dogs, a couple of fingers should be used, and a towel placed over the dog's chest to avoid inflaming the skin. Whilst for larger dogs using both hands is appropriate. 

For most dogs, each coupage session lasts five to ten minutes, four to five times a day,  in combination with other physiotherapy techniques such as vibrations and postural drainage. The idea is to loosen the secretions to make them easier for the dog to cough up and swallow. 

An ideal protocol: 

• Rest the dog sloping slightly downhill, with the head below the heart
• Coupage both sides of the chest for 30 to 60 seconds
• Vibrations for five to six exhalations
• Repeat for five to ten minutes

Coupage is one element of treatment for dogs with serious respiratory issues. It can be extremely efficacious at breaking down thick respiratory secretions, allowing them to be coughed up. 

To a certain extent, efficacy depends on how often coupage is performed and the skill of the operator. It is also important to use an appropriate protocol, because coupage of a healthy chest can cause problems and be detrimental to the dog's overall well-being. 

The technique works best when the chest is percussed for 30 to 60 seconds, then vibrated for four to six expiratory breaths, whilst the dog rests in a posture that aids the secretions to drain. 

Percussion is best employed after periods of rest or sleep since inactivity promotes secretion buildup. Immediately after the session the dog may cough, but should then breathe more easily. Coupage sessions should be continued until the dog's overall condition improves. Regular assessment by the physiotherapist will guide the owner as to when coupage is no longer needed. 

A qualified veterinary physiotherapist charges in the region of $40to $75 per hour. After an initial assessment, the physiotherapist will advise a protocol for the owner to use at home. Since no special equipment is needed, the costs directly related to coupage are minimal and mainly relate to the physiotherapist's fees. 

However, the bigger picture includes the cost of veterinary care and a workup such as blood tests ($100 to $250), chest radiographs ($150 to $400) and ongoing antibiotics ($40 to $400 depending on the size of the dog.) 

When coupage is performed correctly there are relatively few risks. Complications can arise from inappropriate technique, such as using too much pressure, which can lead to rib pain and skin bruising. 

Pneumonia can arise as a result of inhaling food or liquid into the lungs. One example of how this can arise is the clumsy dosing of liquid medicines, whereby the dog doesn't get enough time to swallow and the liquid flows down into the lungs. Care should always be taken when dosing with liquid medications, and slowly syringe the fluid in whilst giving the dog a chance to swallow between mouthfuls.

Also, conditions such as megaesophagus can lead to swallowing difficulties and fluid or food aspiration. Recognizing there is a problem and getting an early diagnosis can empower the owner to adopt strategies such as hand feeding, raising up the food bowl, and keeping the dog's forequarters elevated for ten minutes after eating, all of which aid swallowing and reduce the likelihood of aspiration pneumonia.