objective: to describe the effects of chest physiotherapy in preventing respiratory complications in a child with acquired immunodeficiency syndrome and a giant pneumatocele. case description: an eight-year-old female child was sent to the physiotherapy service of a university hospital due to pulmonary hypersecretion, repeated pneumonias and presence of a giant pneumatocele. the physiotherapy team selected active airway clearence techniques and expiratory flow techniques to promote pulmonary hygiene and to reduce risks for respiratory complications. the follow-up around was accomplished by a multiprofissional team with the objective of avoiding recurrent pulmonary infections, pneumatocele's rupture and need for long-term hospitalization. the child's pulmonary condition remained stable and no changes in the size of the pneumatocele were seen in repeated x-rays. comments: the role of chest physiotherapy in patients with giant pneumatoceles is not well defined in the literature. there is no evidence of beneficial effects of this therapy and there are no guidelines that address the most efficient and safest techniques. currently, much is discussed about the risks and complications arising from chest physiotherapy. in this case, regular physiotherapy intervention was important to maintain child's pulmonary integrity, but studies are needed to evaluate techiques and clinical relevant effects.