One of the main goals of the respiratory physical therapy is to help people who are suffering from accumulating of secretions in their airways and lungs.

Chronic Obstructive Pulmonary Disease (COPD) patients are often hospitalized with an Acute Exacerbation of their medical condition.

Those patients usually get only the standard medical care during the acute phase and don't get respiratory physical therapy treatment.

The study's main aim is to investigate if respiratory physical therapy treatment in addition to standard medical care during the acute phase, can improve the respiratory and medical condition and reduce hospitalization stay.

In order to do so we will compare three groups of COPD patients during acute exacerbation; two groups will get one out of two respiratory physical therapy techniques; manually or Intrapulmonary Percussive Ventilator (IPV) in addition to standard medical care and the third group will get standard medical care alone.

Inclusion Criteria:

• clinical diagnosis of Acute Exacerbation of COPD or Acute Exacerbation of Chronic Bronchitis
• Respiratory Rate>25
• PaCO2> 45 mmHg
• 7.35 < PH < 7.38

Exclusion Criteria:

• intubation
• apnea
• glasgow coma scale < 8
• pneumothorax
• FEV1 < 50% predicted
• Ischemic Hearth Disease