Respiratory conditions are a very common presentation in community and hospital settings, with a wide variety of diagnoses being assessed and treated by physiotherapy. Conditions which can present include pneumonia, chronic bronchitis, asthma, bronchiectasis, cystic fibrosis, hyperventilation and chronic obstructive pulmonary disease. Physiotherapists are trained to assess respiratory conditions and manage, treat and advise on them. Respiratory skills are an important part of every physiotherapist's training and early work, if they have a job in an acute area of practice. It is a difficult skill to learn and physiotherapists have a lot of responsibility for managing acutely unwell patients in hospitals.
Physiotherapy assessment starts with reading the patient's clinical notes to get a view of the history and the medical examination and treatment. The physio must understand the medical opinion and the blood gas and blood test results. Whilst introducing themselves and questioning the patient about their problems the physiotherapist observes the patient's condition. Important aspects of how the patient looks are their weight, how well they look, how much work they have to do to breathe, whether they are using neck and arm muscles to fix the chest as they breathe, the number of breaths they take per minute (respiratory rate), the colour of their hands, lips or nose and the oxygen or other treatments being applied.
Having gathered a lot of information very efficiently by observation the physiotherapist can then decide what form the objective examination should take. The patient's lung expansion and air entry are assessed by the physiotherapist feeling the rise of the ribs with their hands and deciding if it is normal and the same on both sides. Listening to the chest via stethoscope indicates the status of air entry to the peripheral airways, whether there are any areas of consolidation, collapse or bronchospasm giving wheeze. This part of the assessment will indicate how much further investigation is needed and what treatments might be indicated.
Initial treatment concentrates on deciding whether the patient is getting the correct concentration of oxygen. If the patient's oxygen saturation is low then oxygen could be prescribed at a particular percentage such as 24% or 28% through a specific device which ensures the correct percentage. The correct oxygen level is extremely important to maintain before any other treatments are attempted as too much or too little oxygen administration can be harmful. Due to the drying effects of constant gas delivery the oxygen should be humidified through a system which heats the gas as it humidifies it.
The physiotherapist will then move on to the efficiency of air entry into the lung peripheral airways, as the airways can become blocked by sputum from infections or may collapse down. This compromises air entry and reduces the patient's ability to maintain blood oxygen levels. Breathing exercises are taught initially by the physiotherapist to attempt clearance and re-inflation of the collapsed airways and if that is not successful then IPPB (Intermittent Positive Pressure Breathing) can be used. IPPB uses a machine to force air at a controlled volume into the patient's lungs at a greater volume than they can do themselves.
Sputum retention in the lungs occurs when the patient is unable to expectorate the secretions which are formed by infections and worsened by lying in bed in hospital. Active cycle of breathing is a typical physiotherapy technique taught to patients, allowing them to move secretions from peripheral airways to the central airways where they can be removed by huffing or coughing. The technique involves steadily increasing depth of inspiration with longer expirations under slight pressure, avoiding the tendency to increase the bronchospasm of the airways. Patients can become very good at practicing this technique, allowing them to self treat effectively.
Physiotherapists can also apply manual techniques directly to the chest, using vibration or clapping to mechanically disturb the secretions and make coughing and expectoration more likely. Flutter devices are useful to mechanically disturb the sputum as the patient breathes in the vibrating air, again promoting coughing. Surgery to the thorax or abdomen or fractured ribs can inhibit deep breathing and coughing and physiotherapists will encourage patients to take regular pain control medication and to support the wound or painful part whilst practicing their inspiration and huffing. - 16004
Physiotherapy assessment starts with reading the patient's clinical notes to get a view of the history and the medical examination and treatment. The physio must understand the medical opinion and the blood gas and blood test results. Whilst introducing themselves and questioning the patient about their problems the physiotherapist observes the patient's condition. Important aspects of how the patient looks are their weight, how well they look, how much work they have to do to breathe, whether they are using neck and arm muscles to fix the chest as they breathe, the number of breaths they take per minute (respiratory rate), the colour of their hands, lips or nose and the oxygen or other treatments being applied.
Having gathered a lot of information very efficiently by observation the physiotherapist can then decide what form the objective examination should take. The patient's lung expansion and air entry are assessed by the physiotherapist feeling the rise of the ribs with their hands and deciding if it is normal and the same on both sides. Listening to the chest via stethoscope indicates the status of air entry to the peripheral airways, whether there are any areas of consolidation, collapse or bronchospasm giving wheeze. This part of the assessment will indicate how much further investigation is needed and what treatments might be indicated.
Initial treatment concentrates on deciding whether the patient is getting the correct concentration of oxygen. If the patient's oxygen saturation is low then oxygen could be prescribed at a particular percentage such as 24% or 28% through a specific device which ensures the correct percentage. The correct oxygen level is extremely important to maintain before any other treatments are attempted as too much or too little oxygen administration can be harmful. Due to the drying effects of constant gas delivery the oxygen should be humidified through a system which heats the gas as it humidifies it.
The physiotherapist will then move on to the efficiency of air entry into the lung peripheral airways, as the airways can become blocked by sputum from infections or may collapse down. This compromises air entry and reduces the patient's ability to maintain blood oxygen levels. Breathing exercises are taught initially by the physiotherapist to attempt clearance and re-inflation of the collapsed airways and if that is not successful then IPPB (Intermittent Positive Pressure Breathing) can be used. IPPB uses a machine to force air at a controlled volume into the patient's lungs at a greater volume than they can do themselves.
Sputum retention in the lungs occurs when the patient is unable to expectorate the secretions which are formed by infections and worsened by lying in bed in hospital. Active cycle of breathing is a typical physiotherapy technique taught to patients, allowing them to move secretions from peripheral airways to the central airways where they can be removed by huffing or coughing. The technique involves steadily increasing depth of inspiration with longer expirations under slight pressure, avoiding the tendency to increase the bronchospasm of the airways. Patients can become very good at practicing this technique, allowing them to self treat effectively.
Physiotherapists can also apply manual techniques directly to the chest, using vibration or clapping to mechanically disturb the secretions and make coughing and expectoration more likely. Flutter devices are useful to mechanically disturb the sputum as the patient breathes in the vibrating air, again promoting coughing. Surgery to the thorax or abdomen or fractured ribs can inhibit deep breathing and coughing and physiotherapists will encourage patients to take regular pain control medication and to support the wound or painful part whilst practicing their inspiration and huffing. - 16004
About the Author:
Jonathan Blood Smyth is a Superintendent of Physiotherapy at an NHS hospital in the South-West of the UK. He specialises in orthopaedic conditions and looking after joint replacements as well as managing chronic pain. Visit the website he edits if you are looking for physiotherapists in Brighton.
