Therefore, the chest physical therapist had to induce coughing by stimulating the oral pharynx with a suction catheter. Treatment lasted about 45 minutes, at which time breath sounds were clear to auscultation. A repeat chest roentgenogram revealed clearing of the left lower-lobe atelectasis. Two days later, the patient again developed radiologic evidence of left lower lobe and lingula atelectasis (Fig. 3), along with tubular breath sounds over most of the left lung. The chest physical therapist again performed treatment, which consisted of bronchial drainage to all segments of the left lower lobe and lingula, vigorous percussion, vibration, and breathing exercises, along with assisted coughing. No cough stimulation was necessary. A repeat chest roentgenogram revealed clearing of the lingula and left lower lobe (Fig. 4). The presence of pulmonary complications necessitated the use of chest physical therapy despite patient discomfort. When deciding whether to use chest physical therapy one must consider the alternatives: the complications of bronchoscopy, possible development of pneumonia, the need for reintubation, and the hazards of anesthesia.