Respiratory physiotherapists (PTs) are trained in providing specific skills and targeted techniques towards respiratory and breathing issues. Such skills can include airway clearance techniques, exercise advice and pulmonary rehabilitation, inhalation therapy and breathing retraining.
PTs are well positioned to work alongside respiratory physicians and GPs in the community. The nature of this set-up optimises patient flow and continuity of care – patients can see a respiratory physician and physiotherapist in a timely manner avoiding issues such as loss to follow up or waitlists due to staffing and funding pressures that are a common occurrence in a tertiary setting.
Pulmonary rehabilitation (PR) is one of WA’s best kept secrets that has potential large cost savings for the healthcare system. Research shows that PR is one of the most effective treatments for people with lung disease (particularly if they are limited by breathlessness) to improve their breathing and wellbeing.
The 6-8-week evidence-based exercise and education program led by physiotherapists provides people with the skills they need to manage their breathlessness, stay well and out of hospital. PR programs involve a combination of resistance and aerobic exercises which can improve oxygen consumption and functional exercise capacity.
Programs also serve to improve the psychological wellbeing of participants through providing a social support, bringing people with like conditions together, which can improve their ability to cope with their disease and positively influence health-enhancing behaviours.
Currently, in the tertiary setting, among people with COPD who are suitable for a pulmonary rehabilitation program, referral is suboptimal. It is likely this is also true in primary care. Respiratory physiotherapists in the community have strong knowledge of PR programs and where not able to provide PR themselves can act as a catalyst to finding appropriate programs in the community for people with lung disease.
Airway clearance techniques (ACTs), colloquially termed ‘chest physio’ are techniques used to assist mucociliary clearance to move secretions in the airways when normal functioning is impaired. In chronic suppurative lung disease having a regular ACT regimen can assist in preventing exacerbations and optimise respiratory status.
Airway clearance regimens should be individualised with consideration of the patient’s disease, pathology, age, preference and motivation. Respiratory physiotherapists are well trained in selecting appropriate techniques with the aim to achieve maximum efficacy with minimal treatment burden.
There has been a paradigm shift in the selection of ACTs in adults over the past 30 years. Physiotherapists are no longer routinely recommending ‘tipping’ for postural drainage or ‘chest clapping’ as percussive therapy. New ACTs rely on modifying airflow to move behind pulmonary secretions and modulate expiratory airflow to move secretions proximally in the airways.
Techniques such as the Active Cycle of Breathing Technique (ACBTs), positive expiratory pressure (PEP) and oscillating-PEP, and autogenic drainage (AD) are newer techniques that achieve superior outcomes with minimal side-effects.
Inhalation therapy including nebulised saline can be considered as an adjunct to ACTs to promote airway hydration and alter the viscosity of secretions.
Advances in equipment have seen hand-held portable mesh nebulisers introduced which allow for smaller medication particles to be delivered to the small airways of the lungs. These nebulisers are light weight and quieter than traditional compressor nebulisers enhancing the likelihood of adherence to treatment. The timing and order of inhaled medication when performed with airway clearance techniques is important in achieving optimal outcomes.
Breathing pattern disorders (BPD) or dysfunction breathing are terms describing breathing disorders in people that have developed a chronic abnormal breathing pattern in the absence of any responsible organic causes. The development of abnormal breathing patterns can lead to a variety of sensations and unpleasant symptoms with the most common symptom being breathlessness.
Currently, there is no gold standard diagnostic method for BPD. Cardiopulmonary exercise tests (CPET) can identify abnormal ventilatory responses, however, access to these tests is limited. More commonly used are questionnaires (Nijmegen) and outcome measures such as the Breathing Pattern Assessment Tool (BPAT). Physiotherapists trained in treating BPD can assist in restoring a normal breathing pattern. Through structured assessments they can identify triggers and contributing factors including musculoskeletal conditions and/or postural control impairments for which they can then formulate targeted treatments.
Key messages
- Respiratory physiotherapists are well positioned to work alongside respiratory physicians and GPs in the community
- Airway clearance techniques should be considered for people with chronic suppurative lung disease
- Referral to a respiratory physiotherapist for pulmonary rehabilitation should be considered for people with lung disease.
Author competing interests – nil