Written by Wayne Spiteri
Physiotherapists are currently on the frontline assisting coronavirus patients during this pandemic.
“Physiotherapy” is no new word for us – we have heard it before but it does not mean we are aware of what it means being a physiotherapist, more specifically; a chest physiotherapist.
It is common knowledge that the role of a physiotherapist is to help people affected by injury, illness, or disability through education and advice, movement, exercise, and manual therapy. The profession utilises the knowledge and skill to improve a range of musculoskeletal, neurological, cardiovascular and respiratory conditions.
Chest physiotherapy is a term used for physiotherapy treatments that are targeted towards issues in the lungs. It is designed to clear the airway, improve respiratory fitness, and improve general fitness, after assessing the patient. The treated conditions include respiratory diseases such as Chronic Obstructive Pulmonary Disease (COPD), Cystic Fibrosis (CF) and Asthma, as well as respiratory infections such as Pneumonia and more.
The assessment
There are several ways by which physiotherapy can be used to treat respiratory problems, depending on the cause of the condition. The physiotherapist initially conducts a full respiratory assessment which will include an in-depth discussion about the past health history and risk factors for respiratory diseases, a visual analysis of the physical manifestation of the condition, and a physical examination where the chest wall is palpated and examined.
Routine tests such as; an examination of the cough mechanism, breathing rate and pattern, sputum examination, and auscultation of all the lobes of the lungs are also carried out. This assessment will allow the physiotherapist to gain knowledge about the person’s lifestyle and condition and to carefully assign the correct techniques and treatment in order to improve the condition and address the main complaints.
Clearing the airway
Many respiratory conditions are characterised by the build-up of thick fluid, called mucus. It is the chest physiotherapist’s responsibility to guide the person with regards to the mucus’ active and passive drainage techniques from the airway.
Active techniques include Active Cycle of Breathing Techniques (ACBTs) which apart from calming the person down, also help bring up mucus from the bottom of the lung so that it can be expectorated through a huff. Autogenic Drainage is another alternative where the chest physiotherapist verbally guides the person on how to bring up the mucus from the deepest part of the lungs, to the middle segment, and to the top. The exercise is ended with a huff, to remove the mucus.
Passive techniques include postural drainage which is the adequate positioning that allows gravity to drain such fluid. It is important to have knowledge of such postures and how to guide the patient into getting into them, especially a post-op patient. These also encompass techniques where the physiotherapist uses their manual skill to perform percussions and vibrations to the chest wall. Here, the rhythmical striking of the chest wall dislodges secretions allowing the fluid to be mobilised and to eventually be removed from the central airways. Physiotherapists also educate in using take-home devices such as the Acapella which offer an alternative to shaking and vibrations, as apart from strengthening the muscles of inspiration, it shakes the chest wall on expiration also dislodging said mucus. These help to increase patient independence and functionality, which is always an aim of treatment.
In situations where one is physically unable to remove such mucus, chest physiotherapists are trained to manually suction it from the airway using a catheter.
Improving respiratory efficiency
Once the airways are clear, the chest physiotherapist will most often proceed to breathing exercises where lung expansion is promoted, and respiratory muscles are strengthened. Lung expansion will allow the person to breathe in more air. This is particularly useful when a segment of a lung is collapsing, as with the use of manual resistance the part improves its inflation. Respiratory muscles can also be strengthened through similar techniques. Here manual resistance is applied to muscles, most often to the diaphragm, making breathing harder for the individual, and increasing the contractibility of the muscle. With a stronger contraction, inspiration and expiration occur more efficiently and effortlessly.
Improving general health
One does not only benefit from chest physiotherapy if he or she has a life-threatening respiratory condition. Chest physiotherapy will produce a snowball effect in both healthy and unhealthy individuals. This is because it increases the ability of oxygen to be taken up by the lungs potentially increasing blood oxygenation. This will, in turn, reflect improved cardiovascular health as the cardiovascular system will be able to deliver more oxygen to the desired tissues. Increased levels of oxygen at muscles, amongst other structures, improves aerobic respiration and hence performance and endurance.
Whilst breathing may seem like a simple matter of inhale-exhale to most of us, it shouldn’t be taken for granted. Individuals with serious respiratory problems might struggle to do the simplest of tasks due to shortness of breath, potentially resulting in various disabilities. With the help and advice of a chest physiotherapist, adaptations can be made to one’s lifestyle and behaviour, making breathing considerably easier. This will not only manifest physically, but will also improve psychological health, and the overall quality of their day-to-day life and well-being.