Doctor in Xcell Physiocare
Patient Review Highlights
People suffering from pneumonia, postoperative partial or complete collapse of the lungs, chronic respiratory conditions like Chronic Obstructive Pulmonary Disease, Cystic Fibrosis etc as well as people suffering from neuromuscular diseases can get partial relief by respiratory physiotherapy. If a person is suffering from retained secretions, increased effort to breathe or volume loss, he or she may be referred to Respiratory Physiotherapy.
Respiratory Assessment Of The Patient
A Respiratory Physiotherapist will assess the condition of the patient with the help of Respiratory Assessment or Respiratory Examination. It includes:
Auscultation and review chest X-Ray
Interpreting arterial blood gasses test and blood tests
History of present illness
History of past illnesses
Respiratory Physiotherapy Techniques -
After the Respiratory Assessment the doctor may prescribe the following:
Exercises like Active Cycle Of Breathing Techniques can help in clearing phlegm. Since people in respiratory distress often produce more phlegm than normal, it is essential that this excess phlegm be removed. This can help the person breathe more freely. Removing the phlegm can also help prevent infections in the chest and reduce coughing. It is a set of exercises that together help in establishing breathing control, huffing and deep breathing.
Early mobilization is one of the most important aspects of chest physiotherapy. It includes positioning, active and passive turning, cycling pedals, standing, stepping etc.
The Physiotherapist may apply pressure on the chest to facilitate airway clearance while keeping the patient in gravity assisted phlegm drainage position.
It employs a device that helps patients take a deep breath, cough and clear lungs. The device offers short-term and intermittent mechanical ventilation of a positive pressure set by a physiotherapist. The device pushes a mixture of oxygen through a facemask.
Here too the physiotherapist uses a device to suck out excess mucus from the chest and facilitate breathing. Here the cough is stimulated by a catheter and phlegm is sucked out using another catheter.
It is the acronym for Manual Hyperinflation. This procedure is carried out by a Respiratory Physiotherapist to give volume to partially or completely collapsed lungs.
BiPAP or CPAP
The device delivers pressurized air into the patient's airways through a facemask. The pressure of air prevents collapse of the throat muscles and reduces airway obstructions. In essence, they allow patients to breathe more freely and regularly.
Right Respiratory Assessment or Respiratory Examination is crucial to applying the right physiotherapy techniques. Right techniques may help patients breathe more freely and avoid respiratory infections.
Over the last couple of decades, most chronic diseases are being treated by modes other than just medications. Physiotherapy is one such approach, and the success rate has been quite high.
The lungs are extremely vital organs in that they supply oxygen to the entire body, which in turn ensures optimal body functioning. When the ability of the lungs to perform is reduced, which happens in chronic lung diseases, then each organ in the body is affected. Therefore, the lung’s ability should be restored so oxygen supply to all organs is improved.
Symptoms of chronic lung disease:
- Shortness of breath, with even minimal exertion
- Reduced exercise tolerance
- Tightness and fullness in the chest
- Excessive mucus secretion in the lungs
Physiotherapy aims to improve lung function by a combination of measures
- Improve breathing techniques
- Improve posture
- Improve mucus secretion
- Improve lung capacity
The patient is taught various techniques which help in both chronic cases and in acute exacerbations.
- Posture: In most chronic lung diseases, the patient assumes a stooped posture with bent shoulders. This reduces the capacity of the upper lungs. The patient is made to consciously keep the shoulders upright and arms extended so that the upper lungs are available for breathing. Shoulder, neck, and thorax movements are practiced so that each breathing cycle provides greater ventilation and improves oxygen supply to the body.
- Breathing: The patient is taught to breathe with full force on the diaphragm. This makes the lower chest movements effective and improves ventilation in those areas. The patient is also taught pursed-lip breathing, where forceful expiration is practiced. This again improves lung efficiency. This practice of coordinated breathing helps.
- Posture drainage: With a combination of clapping and shaking, the patient is taught to work on the affected lung areas. This allows for removal of mucus from the lungs, thereby improving lung capacity. The patient may sometimes be required to induce coughing to clear secretions.
- Overall exercise: Though chronic lung diseases reduce overall ability to exercise, the key is to maintain an active lifestyle and practice a regular workout regimen. This ensures ventilation and circulation are maintained at optimal levels. It would be a vicious cycle if a person stops regular exercise due to chronic lung diseases.
Lifestyle changes: In addition to the above physiotherapy, the patient also should quit smoking, reduce exposure to dust and pollution, and use a protective mask when possible. Eating healthy and getting adequate sleep is also essential in the long run.
The lungs take in oxygen and leave out carbon dioxide through breathing. It often does not get noticed but is the most vital function. When a person is not able to breathe properly, then the overall physical ability of a person is reduced. Even walking a few steps or doing simple chores can seem daunting tasks. Therefore, shortness of breath can be very limiting and may alter the quality of life of the patient.
The medical term being dyspnea, it can be short or long-term, acute or chronic. Any problem in the heart or lungs can cause shortness of breath.
Shortness of breath can be caused by various conditions including:
- Lung infections
- Heart conditions including congestion and failure
- Any systemic illness or infection
- Chronic obstructive pulmonary disease
Given that shortness of breath is caused by almost any ill health condition, especially in people with chronic conditions, it is best that the lungs are empowered to improve their function and do not cause shortness of breath. The idea is to delay the onset of shortness of breath and also to reduce the severity.
Some techniques to reduce shortness of breath are:
- Breathe by reducing the rate of respiration. This reduces shallow breathing, which often happens, and so improves the amount of oxygen that reaches the system with each breath.
- The patient should learn to relax, sit, and pace around without exertion.
- Become aware of air movement during respiration – controlled breathing and active cycle of breathing techniques.
- Postural drainage – Depending on the area of the lung that is causing shortness of breath, the person is made to lie prone and turn to a side that will allow the fluid in that region to drain out.
- Overall relaxation techniques to improve airflow and control short of breath.
- Avoid bending down, as it can induce shortness of breath.
- Over-eating at one go in one meal should be avoided.
- Weight needs to be maintained, especially if not under control. This can lead to shortness of breath without any associated medical condition either.
- The patient should learn to push objects instead of pulling them.
- Heavy objects should not be lifted but moved down at ground level.
- Avoid extreme hot or cold showers.
- Quit smoking as it causes various lung problems.
Help physiotherapy provides for people who are short of breath:
- Improve exercise tolerance
- Calms the person
- Allows the person to control symptoms
- Improve the quality of life
- Provide manual treatment
Asthma is a very common respiratory disease and a chronic lung problem, which causes trouble in breathing. It may cause a lot of inconveniences, but everything can be managed. Although the root cause of this disease is not known exactly, exposure to pollutants, genetics and other particles can aggravate it. Asthma can affect the lifespan and quality of your life, but noticing it in advance and proper treatment can help you live a normal life as anyone else does.
The lining of the bronchial tubes gets swollen when a person has an asthma attack. This makes it very difficult for the person to breathe. Most of the times, doctors recommend inhalers, which should be kept handy and used at the time of the attack. But apart from medication and inhalers, there are also other effective treatments available which can help control an attack using a variety of techniques. Physiotherapy is the best treatment to reduce the frequency and severity of the asthma attack.
How does a physiotherapist help?
Physiotherapists use a variety of methods for treating asthma such as breathing techniques, retraining breath and many more. You will have to follow these techniques in combination with the medication prescribed by your doctor. If you feel your asthma is under control, instead of using physiotherapy as a replacement to the prescribed medicines, you can speak with your doctor and get your dose reduced.
There are basically two types of breathing techniques followed by the physiotherapists:
- Breathing retraining
- Buteyko breathing
The breathing retraining technique aims at making the breathing patterns normal. The Buteyko breathing technique aims at hyperinflation. This is also a kind of breathing retraining technique.
Training the Respiratory muscles:
Many people who have asthma, avoid exercise or activities that are physically exerting. This is due to the fear instilled in them of an asthma attack. It is not just the physical activities that cause asthma, there are many other things. So, when you avoid physical activities, then you are gradually losing the body’s ability to breathe. This is going to worsen the condition when you have an attack. But your physiotherapist will help you train the respiratory muscles which will help you with proper breathing and also increase the physical activities. This can be done with respiratory devices at the beginning and then you can go for exercises or other physical activities.
Timing and Rhythm method:
When you are unable to breathe normally during an attack, it is always good to take smaller breaths. Air passage and lungs will relax due to this method of breath retraining. You can also use other routes of breathing such as breathing in with your nose and trying to breathe out with your mouth. It is always good to work along with your physiotherapist and doctor together. Medicine and physiotherapy should go hand in hand.
Breathing is the most vital of all functions, one which ensures the body functions seamlessly. It also becomes so effortless that we do not make a conscious effort to breathe. However, if we learn to do it properly, good breathing techniques have multiple benefits, with improved efficiency being the most important. Those who have mastered the art of good breathing techniques, be it pranayama or otherwise, will vouch for this fact.
Some of the other benefits of learning good breathing techniques are:
- Improved lung capacity
- Improved circulation
- Increased energy levels
- Relaxes body and mind
- Improves digestion
- Improved sleep
- Stress management
- Reduces anxiety
- Reduces migraine
- Improves body function at a cellular level
When learning breathing techniques,
- Be aware of your surroundings. Choose a quiet place
- Be comfortable in terms of clothing and seating
- Try to get it into a routine – same time of the day, each day
- Build it into your pattern – helps ease stress.
Techniques: Listed below are some highly effective, tried and tested measures for improving breathing.
- Deep breathing: Sitting in a comfortable position, keep one hand on your belly and the other on your chest. Breathe in through your nose and exhale slowly. Feel the air move through the nose, windpipe, and into the lungs and the same way out. There should be a sense of peace filling your body as you do this. Doing this for 15 to 20 minutes daily can vastly improve lung capacity
- Equalized breathing: The focus here is to provide an equal amount of time for filling in the lungs and exhaling it. Seated comfortably, try to breathe in, to your lung’s full capacity, by counting to a particular number (5 to 6). Similarly, try counting out and exhale. Repeat this for about 10 to 15 times.
- Pranayama: In time-tested yoga, pranayama is the name for controlled, deep, relaxed breathing. Learning to control breathing also improves overall health and reduces stress. It helps to realize the flow of air through the body, which also leads to improved function at a cellular level.
- Muscle relaxing breathing: In a lying down position, when breathing in, the feet and calf muscles are tensed. With breathing out, the same muscles are relaxed. With each cycle, the muscle group addressed should be moving from the legs, calves, abdomen, chest, arms, shoulders, neck, and face. This ensures the muscles are relaxed totally.
- Modified Lion’s breath: When the lungs and abdomen are filled with air, then the air is released totally using an “aaahhh” sound.
Try these techniques to see your breathing efficiency and lung function increase. Your overall health will definitely increase.
The lungs are responsible for taking in and filtering out oxygen which is then supplied to the body via circulation. They are also responsible for removing the carbon dioxide from the body. This happens through breathing, and though no effort is required, when the function is impaired, the entire body system takes a toll.
Lung function can be impaired by a multitude of issues including infections like pneumonia, chronic diseases like COPD and pulmonary hypertension, heart conditions like a congestive failure, etc. While the acute cases would go off once the infection is treated, the long-term conditions are helped by physiotherapy in addition to medications.
The lungs are made up of elastic tubules and have the ability to hold secretions. Therefore training the lungs to improve their function via exercise can help improve overall lung function. Some of the routine exercises are simple ones as below.
- Active breathing: The patient is taught to breathe in a more aware manner so that the lungs take in air to their maximum ability.
- Postural drainage: The lungs are like containers for mucus, and over a period of time, they need to be drained. Depending on where the fluid accumulation is, the patient is taught to lie in various positions so that it can be drained, allowing for instant relief.
- Nasal saline rinse: This helps in clearing the secretions and also the saline provides an antibacterial effect to clear off residual infection. Clearing sputum is highly critical for reducing chances of repeat infections and hospitalizations.
- Peripheral and respiratory muscle training: Though it goes unnoticed, breathing also involves neck and shoulder muscles and strengthening these is also essential for effective breathing.
Multiple studies have shown that physiotherapy plays a vital role in lung rehabilitation. As noted above, while the benefit may be not very evident in short-term lung impairment, it makes a significant difference in long-term and chronic conditions like COPD, pulmonary hypertension, and even congestive heart failure. Lung rehab has shown to produce the following changes:
- Reduce episodes of breathlessness and fatigue. A person can gradually resume his normal chores without too much assistance.
- Help in clearing secretions, which can worsen congestion and breathlessness.
- Increase overall quality of life. There could be even people who cannot do routine activities like walking to the bathroom. They could be benefitted with pulmonary rehabilitation.
- Reduce the number of hospitalizations due to mucus accumulation and breathlessness.
- Improve exercise tolerance. It is well known and proven that those who exercise on a regular basis can improve lung function over a period of time.
Emphysema is a lung disease, where the walls of the air sacs are destroyed completely and the lungs lose their elastic gradually. This makes it inconvenient for the person to breathe in/out as the size of the lungs lessens. This, in turn, increases the breathing rate and finally, you may end up with breathlessness. If proper care is not taken, it can also lead to heart enlargement which may further increase your chances of having a heart failure.
Causes of Emphysema:
Some of the common causes of Emphysema are:
- Irrespective of whether you are exposed to direct or second-hand smoking, chemical fumes, pollution you can still be affected by Emphysema. Although one of the main and most common reasons for Emphysema is Smoking. The tobacco smoke has almost 4000 chemicals in it. These chemicals will first destroy the airways, then the elastic sacs and finally the elastic fibers.
- Another reason for Emphysema is protein deficiency, but this is a very rare reason. Only one or two percent of the people will be affected by Emphysema due to this reason. A protein called AAT deficiency can damage the elasticity of the lung structure and can cause lung damage.
- Aging is also a cause of Emphysema. As you grow older, lungs also start aging and hence that can damage the elasticity of the lungs.
Physiotherapy treatment for Emphysema:
When you meet your physiotherapist, you will have a discussion in order to find the actual symptoms of Emphysema. Based on the symptoms, the physiotherapist will analyze how it is affecting your lifestyle.
A physiotherapist will make sure to provide the best and specialized treatment for the symptoms of Emphysema. Your treatment will be decided and started based on the severity of your symptoms.
Your physiotherapist will work on controlling the respiratory rates, Diaphragmatic breathing, reduction of breathing volume and exercises related to relaxation breathing. These techniques will help in retraining your breathing.
The physiotherapist will work on productive and effective coughing techniques, manual assistance which includes shaking and vibrating and postural drainage. They will help in removing the mucus out of the airways as they block the airways. This way you will be able to keep your airways as hygienic as possible. This will also help in reducing any kind of infections that may be caused due to the excessive mucus.
Educating the patients:
Your physiotherapist will help you understand the causes of Emphysema, how the allergens and environment are responsible for it, how to manage your medication and how to identify the possible asthmatic attacks.
With the help of physiotherapy, Emphysema sufferers will be able to lead a normal life as much as possible.
Seeing someone who used to do all their activities on their own turn to someone who needs help even with small things like going to the bathroom can be very difficult.
The lungs are vital organs in that they are essential to supply oxygen to the entire body. If the various organs do not receive adequate oxygen, their function can be impaired. Therefore, lung function needs to be maintained. Lung function can be impaired by chronic conditions like COPD and bronchiectasis. In both these, the overall ability of the lungs to take in adequate oxygen is reduced. Therefore, the lungs need to be rehabilitated so that they can improve their ability to function better. These exercises are aimed at the following:
- Improve ability to breathe effectively
- Reduce episodes of breathlessness
- Reduce the number of hospitalizations required to clear sputum and infections
- Improve ability to perform small, routine chores on their own
- Improve exercise tolerance over a period of time
- Improve overall quality of life
- Reduce morbidity and mortality rates
It has been proven beyond doubt that in addition to medications, physiotherapy plays a vital role in improving lung function over a period of time. Depending on the actual condition of the patient, a physiotherapy program is drawn up. Initially, the therapist will guide the patient and/or the caretaker with the various exercises. Over a period of time, the caretaker and the patient can do these on their own. The intent of these common exercises is to improve breathing efficiency, clear mucus, and improve overall lung function.
- Active breathing techniques (ABT) – We all know that breathing is involuntary; however, making an effort to consciously breathe can improve the efficiency. More oxygen is taken in and sent to the various organs, thereby rejuvenating the entire body.
- Postural drainage: With any chronic lung condition, sputum or mucus tends to accumulate in various parts of the lungs. If not drained, it can attract more bacteria and cause infection. The patient is made to lie in various positions so that different parts of the lungs are drained, aided by gravity. This is highly effective in clearing secretions.
- Pursed lip breathing: Inhaling through the nose and letting the air out through the mouth like how a candle is blown helps improve lung function.
- Forced coughing: A person is taught to induce coughing so that secretions are cleared out, thereby reducing chances of infection. Inhale as usual to the full capacity and exhale in coughing spurts.
It has been proven beyond doubt that with no side effects (unlike medications), physiotherapy improves the overall quality of life in people with COPD.
Sputum production and chronic cough for at least three months in a year, consecutively for two years is termed as Chronic Bronchitis. Emphysema and Chronic Bronchitis are different from each other but are covered under the same umbrella COPD, which means Chronic Obstructive Pulmonary disease and that is because both are diseases related to respiration.
How is Chronic Bronchitis different from Emphysema?
Both of them occur when the airways in the lungs get damaged due to the inflammation of the airways. Emphysema is the result of air sacs break down whereas Chronic Bronchitis is the result of excessive mucus formation and inflammation in the Bronchi. Some people show either of the symptoms while some people show combined symptoms.
Symptoms of Chronic Bronchitis:
The following symptoms are seen in people with Chronic Bronchitis:
- Long-term cough
- Excessive mucus production
- Sudden weight gain
- Tight chest
- Feeling breathlessness even when you are taking rest
Sometimes, these symptoms will be neglected by many people treating them as symptoms of cold weather, or attributing these symptoms to the presence of too much smoke or fumes around them. But it is always good to consult a doctor if the symptoms persist for a long time.
Physiotherapy and Chronic Bronchitis:
The main goal of your physiotherapy involves exercises that improve tolerance, education, mucus clearance, increase lung volume, reduce exacerbations, and reduce hospitalization.
Exercises that improve tolerance:
Upper and lower limb tolerance training have shown tremendous results in preventing, controlling and managing Chronic Bronchitis. This training helps in airway clearance, reduces airflow obstruction, mucus removal, and increased energy levels.
Usage of different postures for moving the mucus through the throat and removing it through the mouth. There are different postures used for different patients. It is basically done by placing the affected part at a lower height and the unaffected part comparatively higher.
This technique will help in proper and normal airflow through the bronchi. There will not be any blockage of the airway. Retention of carbon dioxide in the lungs will be reduced, the mucus will be removed and airflow through the airways will improve with this technique.
This technique is used by the physiotherapist along with the postural drainage technique. This is also a technique used for clearing the mucus that got stuck in the airways. Many patients find this technique really useful in mucus removal. In Percussion, the physiotherapist claps on the chest of the patient or on the back of the patients. It depends on how the patient prefers. This gives a relaxing and soothing effect on the patients and helps them release out mucus that got stuck in the airways.
Finally, educating the patients about its causes and physiotherapy treatments can help them recover faster. In case you have a concern or query you can always consult an expert & get answers to your questions!