Cold Therapy Prior to Breathing, Coughing Exercises for Chest Tube Pain

The use of cold therapy prior to deep breathing and coughing exercises has been shown to effectively relieve pain in patients with chest tubes, according to the results of a randomized controlled study published in the journal Heart & Lung.

It has been established that the indirect effect of cold therapy on pain is the reduction of edema, muscle spasms, and inflammation by decreasing the pressure on nerve endings, said study authors. In patients who have had chest tubes inserted, pain should be controlled sufficiently to allow patients “to mobilize and effectively perform respiratory exercises,” said study authors. “Though there are studies on the effects of cold therapy after the removal of the chest tube, there are no studies regarding the application of cold therapy before deep breathing and coughing exercises in patients with chest tubes,” study authors noted.

The current study was conducted in the Department of Thoracic Surgery of Düzce University Hospital, a training and research hospital located in Düzce, Turkey. All study participants were patients with chest tubes who had been treated at the hospital between May 2, 2017, and October 24, 2019. The patients had undergone surgical procedures, including thoracotomy, videothoracoscopy, and tube thoracostomy with chest tube insertion. The ages of the 70 patients participating in the study ranged between 18 and 80 years, with an average age of 53.99±18.54 years. BMI values varied between 14.69 and 36.33 kg/m2, with an average BMI of 24.36±4.35 kg/m2.

Researchers administered deep breathing and coughing exercises to all study participants, with patients asked to take a deep breath through the nose, hold it for a count of 5, then exhale slowly through the mouth. This procedure was followed for 3 breaths, with patients asked to cough on the third exhalation. All participants also received analgesics prior to doing these exercises.  

To assess the efficacy of cold therapy, researchers divided participants into 2 groups, an intervention group and a control group, each with 35 participants. In the intervention group, cold therapy was performed around the chest tube using an ice pack for 15 minutes at the time that the analgesics were administered prior to exercise completion. The investigators measured participants’ pain before and after the exercises (before and after the cold therapy/exercises in the intervention group) using the visual analogue scale (VAS).

Results of the study showed that in the intervention group, participants’ pain rates after completing the intervention and deep breathing and coughing exercises was significantly lower before vs after the intervention/exercises (3.31 vs 4.24, respectively, as measured by the VAS; P <.01). Further, the average pain rate after exercise completion was significantly lower in the intervention group vs the control group (3.31 vs 5.29, respectively; P <.05).

Demographic variables such as age-group, sex, marital status, educational background, smoking status, alcohol consumption, and history of chronic disease did not appear to have a statistically significant effect on the difference in pain rates before and after deep breathing and coughing exercises.

A major limitation of the current study is the fact that the participants experienced difficulties in understanding and applying deep breathing and coughing exercises because of the advanced age profile of the individuals involved. They also had difficulties in evaluating the pain scale.

The researchers concluded that the findings from the present study show that the use of cold therapy prior to deep breathing and coughing exercises in patients with a chest tube is effective in the management of pain. The results suggest that new studies should be conducted that are designed to compare other nonpharmacologic methods of cold therapy.


Levent Kıy B, Demiray A, Boran M. The effect of cold application on pain in patients with chest tubes before deep breathing and coughing exercises: a randomized controlled study. Heart Lung. 2022;55:102-107. doi:10.1016/j.hrtlng.2022.04.014