Some respiratory physiotherapy interventions generate a high level of aerosolised droplets that spread widely, which can increase the risk of transmission of respiratory viruses to healthcare workers.

Please make sure respiratory physiotherapy techniques are the most appropriate intervention for your patient with acute respiratory viral illness (including COVID-19).


  • Where respiratory physiotherapy interventions are considered essential, administer where possible in a negative pressure room or single room using contact, droplet and airborne precautions. If this is not possible then efforts should be made to move the patient to a negative pressure or single room as soon as possible.
  • Respiratory (chest) physiotherapy interventions include airway clearance techniques (active cycle of breathing technique, forced expiratory technique, percussion and vibrations, positive expiratory pressure (PEP) therapy (including bubble PEP), positioning and gravity assisted postural drainage, intra or extra pulmonary high frequency oscillation devices, autogenic drainage), secretion clearance removal (huff and cough, suctioning, assisted or stimulated cough manoeuvres, cough assist machine), and mobilisation and exercise prescription which may trigger a cough and/or sputum expectoration.
  • During techniques which may encourage or provoke a huff or cough, cough etiquette and hygiene is essential.
    • Teach techniques, then leave the room for huff and cough and continue to monitor outside the room if possible, e.g. via telephone.
    • If this is not possible, staff should be positioned ≥2 metres away and out of the ‘blast zone’ or line of cough.
    • Teach cough hygiene including encouraging turning of head away and coughing into elbow and/or encouraging ‘catch your cough’ with a tissue, then dispose of tissue and perform hand hygiene.
  • Avoid nebulisation of bronchodilator medication or saline (refer to Aerosol generating respiratory therapies: nebulisers).
  • Sputum induction should not be performed unless necessary. In this case, ascertain whether the patient is productive of sputum and able to clear sputum independently.
  • Any room which has had an aerosol generating procedure in it requires airborne precautions for a minimum of 30 minutes after. The exact time depends on air changes per hour. Refer to the Clinical Excellence Commission Infection Prevention and Control Novel Coronavirus 2019 (2019-nCoV) – Hospital setting.​​​​


Prioritise respiratory physiotherapy interventions performed independently by the patient over therapist-delivered interventions to reduce the risk of transmission of viruses to health care workers.

Document information

Developed by 
  • Professor Jennifer Alison (University of Sydney, Sydney LHD)
  • Dr Renae McNamara (University of Sydney, Woolcock Insitute of Medical Research , South Eastern Sydney LHD)
  • Clinical Associate Professor Lissa Spencer (Sydney LHD)
  • Associate Professor Zoe McKeough (University of Sydney), Dr Marita Dale (University of Sydney)
  • Dr Ling Ling Tsai (South Eastern Sydney LHD)
  • Dr Mary Santos (South Eastern Sydney LHD)
  • Helen Kulas (Respiratory Network Manager ACI)
  • ACI Respiratory Network Executive, Professor Peter Wark (Clinical Lead, Respiratory COVID-19 Community of Practice, Senior Respiratory Staff Specialist, Hunter New England LHD), CEC
For use byTo assist physiotherapists caring for patients with suspected or confirmed COVID-19 during the COVID-19
Current as at: Wednesday 8 April 2020
Contact page owner: Health Protection NSW