Manual chest physiotherapy (MCP) techniques, involving chest percussion, vibration and assisted coughing, have long been used in the treatment of respiratory conditions. However, strong evidence for the benefit of this intervention is lacking. Specifically with respect to chronic obstructive pulmonary disease (COPD), a review of the research literature indicates a clear state of clinical equipoise. Traditionally, patients hospitalised with an exacerbation of COPD have been given MCP to assist with sputum clearance. However, uncertainty as to whether it confers either short- or long-term benefits has led to wide variation in practice, with individual clinical preference tending to dictate whether or not a patient receives treatment. Current clinical guidelines on the management of COPD are unable to provide evidence statements on physiotherapy interventions on account of inherent methodological limitations in existing research. The aim of this study was to address this situation by providing robust evidence on the effectiveness of MCP for this clinical population.