Respiratory Physiotherapy - An Overview

What Is Chest Physiotherapy?

Chest physiotherapy is a series of treatments aimed at removing secretions from the lungs, thereby preventing collapse, reducing the work of breathing, and promoting lung expansion.

What Are the Purposes of Chest Physiotherapy?

The purpose of chest physiotherapy is:

• To reduce the work of breathing.

• To optimize the ventilation-perfusion ratio and improve gas exchange.

• To help in the removal of retained or profuse airway secretions.

• To regulate lung compliance and prevent collapsing.

When Can Chest Physiotherapy Used?

Chest physiotherapy is an important adjuvant treatment for most respiratory illnesses, including COPD (chronic obstructive pulmonary disease), bronchiectasis, and cystic fibrosis, as well as neuromuscular diseases like muscular dystrophy, cerebral palsy, spinal cord injury, and perioperative care, particularly in upper abdominal surgeries. Chest physiotherapy can provide comprehensive respiratory care if administered appropriately.

Respiratory physiotherapy can also be used in COVID-19 (coronavirus disease 2019) patients:

1. Although a productive cough is a less common symptom, it is helpful in the respiratory treatment and physical rehabilitation of COVID-19 patients.
2. If individuals with COVID-19 have airway secretions that cannot be cleared on their own, this treatment is recommended. This might be done on a case-by-case basis, with interventions depending on clinical signs, and it could also be used in high-risk people. Patients with comorbidities such as neuromuscular disease, pulmonary disease, or cystic fibrosis may be affected by hypersecretion or ineffective cough.

What Are the Complications of Chest Physiotherapy?

The complications are:

• Hypoxemia.

• Pain to muscles, ribs, or spine.

• Vomiting and aspiration.

• Acute hypotension during the procedure.

• Pulmonary hemorrhage.

• Bronchospasm.

• Increased intracranial pressure.

• Bronchospasm.

• Dysrhythmias.

How to Check the Need for Respiratory Physiotherapy?

Individuals will need a respiratory physiotherapist if they show the signs of the following:

• Increased sputum production.

• Excessive cough.

• Decreased breath sounds or crackles suggest secretions in the airway.

• Change in vital signs.

• Abnormal chest X-ray consistent with mucus plugging or infiltrates.

• History of respiratory problems treated successfully with PDT (photodynamic therapy), such as bronchiectasis, cystic fibrosis, or lung abscess.

• Rapid changes in arterial blood gas values or oxygen saturation.

What Changes Determine the Effectiveness of Respiratory Physiotherapy?

The following conditions help to determine the effectiveness of treatment, such as changes in,

• Sputum production.

• Modified borg scale dyspnea level.

• Breath sounds of lung fields.

• Arterial blood gas values or oxygen saturation.

• Ventilator variables.

• Peak expiratory flow rate.

• Vital signs.

• Chest X-ray.

What Will Happen During Respiratory Physiotherapist Appointment?

Physiotherapy treatments are available to people of all ages and at all phases of the disease, from early detection to chronic illness, acute episodes, and terminal stage. As a result, physiotherapists play a distinct and unique function in the majority of clinical care pathways. Assessment, consultation, education, and hands-on intervention are all part of the physiotherapist's role in patient care. Respiratory physiotherapists have traditionally assisted in the mobilization and evacuation of secretions. Physiotherapists, on the other hand, can help with a wide range of issues.

They aim to achieve the following:

• Aid in the expectoration of secretions.

• Decrease thoracic pain.

• Increase functional abilities.

• Improve and maintain exercise tolerance.

• Decrease breathlessness and improve breathing.

• Improve the efficiency of ventilation.

The visits with a specialized respiratory physiotherapist will be one-on-one, but if the patient prefer to be accompanied, please bring a friend or relative. The initial consultation will last around one hour. The physiotherapist will obtain a complete written history of the breathing problems during this consultation. Then they will listen to the chest and examine the breathing rhythm. Then, if necessary, the patient will be given counsel, information, and mild exercises to assist in managing his symptoms. The physiotherapist will assess the progress with exercises and then progress the therapy during half-an-hour follow-up consultations.

What Are the Techniques and Devices Respiratory Physiotherapists Use?

There are a variety of airway clearance techniques that can be utilized to promote mucociliary clearance and are classified as follows:

• Manual techniques (low flow and high flow).

• Use of devices (positive expiratory pressure (PEP) and oscillatory positive expiratory pressure).

Patients with respiratory disorders have been using various devices in recent years to aid in the elimination of mucus from the airways and the restoration of pulmonary function. As they provide several benefits, such as independent application, full control of therapy, and convenience of use, these devices appear to boost patients's compliance with daily treatment.

These devices are the following:

• Positive expiratory pressure.

• High-frequency chest wall oscillation.

• Oral high-frequency oscillation.

• Intrapulmonary percussive ventilation.

• Incentive spirometry the flutter.

• Acapella.

• Cornet.

The physiotherapist faces a challenge in choosing the appropriate device for each patient in order to improve daily treatment compliance. As the number of published studies is very less, more controlled studies are required.

In many types of respiratory dysfunction, especially chronic lung disease, such as cystic fibrosis, bronchiectasis, bronchitis, bronchial asthma, and primary ciliary dyskinesia syndrome, chest physiotherapy with bronchial drainage is the standard treatment for mobilization and removal of airway secretions. In individuals with chronic respiratory disorders, chest physiotherapy has been found to be beneficial in maintaining pulmonary function and preventing or reducing respiratory problems.

What Is the Role of a Respiratory Physiotherapist in the Intensive Care Unit (ICU)?

During the management of critically ill patients in the ICU, a continuous evaluation is vital. The outcome of the patient evaluation will also guide the physiotherapist about the best possible treatment. The ICU patient's physiological, motivational, and emotional conditions are constantly changing, necessitating a flexible treatment strategy. Respiratory physiotherapy is vital in the ICU, but it is important to note that the physiotherapist's responsibility in the ICU includes more than just respiratory management; it also includes mobilization and rehabilitation, which has the ability to directly impact the respiratory system.

When to Be Referred to a Respiratory Physiotherapist?

People may have been referred to a respiratory physiotherapist for a variety of reasons:

• In case of a long-term underlying problem or recently diagnosed with problems such as COPD, emphysema, bronchiectasis, asthma, chronic bronchitis, or pulmonary fibrosis.

• Recurrent chest infections or pneumonia may be a problem for the person, or he may suffer from hyperventilation.

• A person may have recently been admitted to the hospital for respiratory problems, or he have been told that his breathing pattern is irregular.

• When walking or exerting, a person may have shortness of breath, or chest injuries, such as rib fractures or bruises.

Conclusion:

For respiratory difficulties, people can consult with physiotherapists and attend therapy sessions. The sessions are programmed to allow them to maintain a regular routine at home in order to keep their respiratory health as manageable as possible. People have benefited by buying devices like deep breathing trainers to improve their symptoms.