Physiotherapists see a very wide spectrum of respiratory conditions in primary and secondary care, learning to manage the assessment and treatment of many chest diseases. Typical conditions seen include cystic fibrosis, asthma, chronic bronchitis, pneumonia, bronchiectasis, chronic obstructive pulmonary disease and hyperventilation. Physiotherapy training in respiratory disease is intensive and detailed, allowing physios to assess and advise on the treatment of most respiratory problems. Respiratory assessment and treatment is difficult to learn and is complicated by the often severely unwell status of the patient, making the physiotherapists take significant responsibility for the care of such patients.
The patient's notes and observation charts are first reviewed by the physiotherapist before going to see the patient, so as to be clear about the medical diagnosis, opinion and treatment. The blood test results will be important and the physiotherapist should have a good understanding of these. The physiotherapist will introduce themselves to the patient and whilst questioning the patient about their illness will be observing their condition at the same time, looking for the rate of respiration, hand, nose and lip colour, oxygen or nebuliser treatments, the overall wellness of the patient, their weight, the effort of breathing they are making and if they are using arm and neck muscles to help breathing.
The observation gives the physiotherapist a lot of information very quickly about the patient's condition and what they need to concentrate on in the examination. They can then move on to the objective examination, starting with assessing the lung expansion and air entry. By holding the chest on both sides, the physiotherapist can assess how well the expansion is occurring and whether it is symmetrical. Auscultation, listening to the chest with a stethoscope, tells the examiner about how well the air is entering the lungs, whether there is a blockage, collapse, consolidation or wheeze. The results of this will determine any further examination and the type of treatments suggested.
The physiotherapist initially looks at the patient's oxygen concentration as the correct level is critical for the patient's respiratory and overall status. If the blood oxygen saturations are below normal then the doctors will prescribe oxygen at a specific percentage such as 24 percent or 28 percent via a venturi type administration device which maintains a constant oxygen concentration as variations in concentration would be damaging. Continuous gas delivery can dry the airways and the secretions, making treatments more difficult, so oxygen should always be administered humidified and heated to body temperature by the appropriate gas delivery circuit.
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.
Physiotherapists specialise in the removal of retained secretions from the lungs, caused by inactivity, reduced ability to breathe and infections. Active cycle of breathing technique encourages the movement of secretions from the peripheral airways towards the central airways where they can be expectorated by coughing or huffing. Physiotherapists teach patients to perform a progression of inhalations and exhalations, gradually increasing the depth of breathing, until the secretions are within reach of a huff. A patient can use this technique very effectively to self treat and avoid any increase in bronchospasm which excessive coughing can cause.
Other techniques physiotherapists use to remove secretions are clapping and vibrations which are manual techniques applied to the patient's chest and which vibrate the airways to loosen secretions and encourage coughing. A flutter device, which vibrates the air as it enters the lungs, can also be used to achieve the same ends. Patients with surgical incisions can be shown how to support the wound whilst coughing, and physiotherapists make sure adequate analgesia is provided to control pain. - 16650
The patient's notes and observation charts are first reviewed by the physiotherapist before going to see the patient, so as to be clear about the medical diagnosis, opinion and treatment. The blood test results will be important and the physiotherapist should have a good understanding of these. The physiotherapist will introduce themselves to the patient and whilst questioning the patient about their illness will be observing their condition at the same time, looking for the rate of respiration, hand, nose and lip colour, oxygen or nebuliser treatments, the overall wellness of the patient, their weight, the effort of breathing they are making and if they are using arm and neck muscles to help breathing.
The observation gives the physiotherapist a lot of information very quickly about the patient's condition and what they need to concentrate on in the examination. They can then move on to the objective examination, starting with assessing the lung expansion and air entry. By holding the chest on both sides, the physiotherapist can assess how well the expansion is occurring and whether it is symmetrical. Auscultation, listening to the chest with a stethoscope, tells the examiner about how well the air is entering the lungs, whether there is a blockage, collapse, consolidation or wheeze. The results of this will determine any further examination and the type of treatments suggested.
The physiotherapist initially looks at the patient's oxygen concentration as the correct level is critical for the patient's respiratory and overall status. If the blood oxygen saturations are below normal then the doctors will prescribe oxygen at a specific percentage such as 24 percent or 28 percent via a venturi type administration device which maintains a constant oxygen concentration as variations in concentration would be damaging. Continuous gas delivery can dry the airways and the secretions, making treatments more difficult, so oxygen should always be administered humidified and heated to body temperature by the appropriate gas delivery circuit.
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.
Physiotherapists specialise in the removal of retained secretions from the lungs, caused by inactivity, reduced ability to breathe and infections. Active cycle of breathing technique encourages the movement of secretions from the peripheral airways towards the central airways where they can be expectorated by coughing or huffing. Physiotherapists teach patients to perform a progression of inhalations and exhalations, gradually increasing the depth of breathing, until the secretions are within reach of a huff. A patient can use this technique very effectively to self treat and avoid any increase in bronchospasm which excessive coughing can cause.
Other techniques physiotherapists use to remove secretions are clapping and vibrations which are manual techniques applied to the patient's chest and which vibrate the airways to loosen secretions and encourage coughing. A flutter device, which vibrates the air as it enters the lungs, can also be used to achieve the same ends. Patients with surgical incisions can be shown how to support the wound whilst coughing, and physiotherapists make sure adequate analgesia is provided to control pain. - 16650
About the Author:
Jonathan Blood Smyth is Superintendent of a large team of Physiotherapists at an NHS hospital in Devon. 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 Bournemouth or elsewhere in the UK.
