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What is respiratory physiotherapy?

It’s fair to presume that many people have little idea of what respiratory physiotherapy is and moreover, what it actually entails; unless of course they have experienced it first hand or alternatively know someone who has for that matter.

For those unfamiliar with respiratory physiotherapy let’s start with the name itself before we go any further. The term refers to the assessment and subsequent treatment of individuals who suffer from medically-diagnosed disorders of the respiratory system, and as such encompasses the likes of chronic bronchitis, emphysema, and cystic fibrosis to name just a few of the well-publicised conditions which affect millions of people.

What’s more, respiratory physiotherapy also expands to include an extensive spectrum of health conditions which impact on the human respiratory system too, for example general surgery and the type of severe illnesses which lead to/demand intensive care provisions.

Most approaches involve the application of various chest clearance techniques, together with dedicated exercise routines and educating care-givers on aspects of pacing and resting positions, so as to enable them to provide individual sufferers maximum functional ability and range of natural motion; whether from a restorative or developmental viewpoint.

Who typically requires respiratory physiotherapy?

There are sufferers of various health conditions – both of a transient nature and more on-going prognosis – who habitually benefit from this more specialised and targeted form of physical therapy; which ultimately the practice of which is designed to help patients who are experiencing/enduring respiratory difficulties or disorders.

As a means of illustrating just who might need the hands on approach advocated by respiratory physiotherapists, please observe the following examples.

Those who suffer from the effects of;

  • Cystic Fibrosis
  • Pneumonia
  • COPD (Chronic Obstructive Pulmonary Disease)
  • Bronchiolitis
  • Asthma
  • Inhaled Foreign Body
  • Lung Disease

 

What does a respiratory physiotherapist do?

A respiratory physiotherapist’s remit is a somewhat extensive and varied one, as it involves playing an active (and crucial) role in all stages of a patient’s treatment programme, including the offering of advice, education and support as well as just the physical elements you might expect from the very outset.

Focusing on the case of respiratory disorders for instance, the physiotherapist can aid in the removal (or mobilisation) of fluid – or secretions – in the respiratory tract, yet this responsibility represents just a small part of the possible physical symptoms that a physiotherapist will address during the course of their working relationship with an individual suffering from a respiratory disorder or disease.

Elsewhere they are tasked with improving the physical strength, flexibility and range of motion in a patient in their care, as well as helping to improve their stamina and cardiovascular health. In addition to this respiratory physiotherapists help their patient to find ways to carry out daily tasks, instigate coping strategies and assist with pain management, whilst also reducing the incidence and severity of breathlessness (courtesy of improving lung capacity and/or breathing efficiency).

Meanwhile they are also on hand to advise and educate patients on healthy habits and practices and in the event of a patient facilitating a mechanical ventilation (and needs to move to non-invasive mechanical ventilation or breathing independently) it’s a respiratory physiotherapist’s job to ably assist in this process.

Typically the first meeting with a respiratory physiotherapist starts with an examination (or individual assessment) once an individual seeking their help/whose been referred by a clinical consultant has received a relevant medical diagnosis.

It’s at this initial stage that they will sit down and look to devise a physical therapy programme for a patient based on that assessment/diagnosis, while also being mindful of their longer-term prognosis. As part and parcel of that original assessment, a respiratory physiotherapist will ultimately afford them a classification derived from their physical capabilities, addressing key movement functionality and envisaging a means of them fully participating in day-to-day life.

Respiratory physiotherapy has a place in the treatment programme at all stages of a disease or illness directly associated with respiratory complaints; commencing from the initial diagnosis and continuing through both chronic and acute phases.  If the prognosis is poor, respiratory physiotherapy can at least provide valuable relief for patients in the terminal stages of their illness.

What exercises are recommended for people suffering from respiratory disorders?

Although there are numerous exercises, beneath are a couple of the core (and universally tried and tested) breathing techniques which are closely connected to alleviating the more traditional symptoms of respiratory conditions; the onset of many of which make it more difficult for patients to catch their breath which in turn can lead to anxiety creeping in to potentially complicate matters still further.

There are the two breathing techniques that can help patients physically recruit the air they need without working so hard to breathe; namely the Pursed-lips Breathing and Diaphragmatic (also called Belly or Abdominal) Breathing technique. Below we document the actions required to perform both in a bite-size instructional guide;

Pursed-Lips Breathing

Benefits include – Slows breathing down, keeps airways open longer (so lungs can get rid of more stale, trapped air), reduces the work of breathing, increases the amount of time an individual can exercise (or perform an activity) and improves the exchange of oxygen and carbon dioxide.

To perform purse-lips breathing;

  • INHALE through the nose (as if smelling something) for about 2 seconds
  • PUCKER lips (like you would if about to blow out candles on a birthday cake)
  • EXHALE very slowly (through pursed-lips, 2 – 3 times longer than you inhaled
  • REPEAT

 

Diaphragmatic (Abdominal/Belly) Breathing

What is it? – With the diaphragm being recognised as the main breathing muscle as such, when you’re diagnosed with respiratory-compromising health conditions the organ’s remit can often be severely restricted. Instead muscles situated in the neck, shoulders and back are recruited by default, however none of these muscles act to circulate air around the body in the same way as a normal-working diaphragm. Which is why it’s important for those suffering from respiratory conditions to retrain their diaphragm to put in additional shifts to compensate.

Experts are the first to admit that diaphragmatic breathing is not as easy to execute as pursed-lips breathing, while the technique is best used when a patient is feeling relaxed, and ideally sitting back (or lying down).

To perform diaphragmatic (abdominal/belly) breathing;

  • RELAX your shoulders
  • PLACE one hand on your chest and the other on your belly
  • INHALE through the nose for roughly 2 seconds
  • When INHALING the belly should move outward and more prominently than the chest
  • PRESS on the belly – gently – when exhaling slowly through pursed lips, as this will push up on the diaphragm to help release air from the body
  • REPEAT

 

What about other exercises designed to improve breathing?

If you’re interested in learning further techniques, then beneath are a couple more rudimentary examples which will serve those who suffer from respiratory conditions well, although we must stress, these are purely listed for general reference purposes and shouldn’t necessarily be acted upon before consulting with your GP/healthcare professional or indeed, respiratory physiotherapist.

Additional entry-level breathing exercises could include;

Huff

This is a forced exhalation of air via the open mouth that helps to move the secretions upwards; for example, as if creating a mist on a window. Normally 2 types are advised;

  • Inhale a medium-sized breath and try and ‘squeeze’ the breath out
  • Inhale a big breath and do a shorter, sharper exhale

 

You should start with the first type of huff and as the secretions move upwards then try the second type. Always remember to allow for an essential short period for relaxation and gentle breathing control after every 1 or 2 huffs, between 15 and 30 seconds should be enough. This will prevent the feeling of tightness in the airways and chest, and allow you to relax and recover your breath comfortably. Remember, relaxed breathing control is also helpful after a bout of coughing.

Deep Breathing

This exercise helps you make better use of the lower parts of your lungs.

Follow these steps;

  • Relax your head, neck and shoulders and place your hands across your stomach, as in the previous exercise
  • Exhale gently
  • Inhale deeply, keeping shoulders relaxed and feeling your ribs rising under your hands
  • Maintain the deep breath for a second, before exhaling gently through the mouth
  • Repeat the exercise 3 – 4 times before resting

 

In summary – and as we’ve already pointed out previously – respiratory physiotherapy can often include exercises and physical manipulation to help clear fluid (or secretions) found on the chest (or lungs) and also incorporate targeted breathing exercises.  However, physical therapy is not limited to this in patients with respiratory disorders, as increasingly respiratory physiotherapy programmes include training to improve stamina and aerobic capacity; all of which are imperative in treating respiratory disorders.

 

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