What is respiratory physiotherapy?
Respiratory physiotherapy is a subspecialty within Physiotherapy focused on preventing, treating and stabilizing breathing dysfunctions or alterations. Its objective is to improve pulmonary regional ventilation, gas exchange, the function of the muscles involved in breathing, dyspnea, exercise tolerance, among other problems.
It consists of a set of techniques and procedures for assessment and functional diagnosis of the respiratory system and therapeutic intervention techniques to unblock the airways, respiratory re-education and re-adaptation to effort.
Why is it performed?
Respiratory physiotherapy is performed in infants and children, adults or elderly people with respiratory pathologies, whether primary or derived from other diseases. Thus, it is indicated for diseases that chronically affect the respiratory system, such as COPD, asthma, cystic fibrosis or neuromuscular diseases. It is also useful for acute processes (pneumonia or lung abscess) or very complex surgical interventions, such as lung, cardiac and hepatic transplants, or other heart and thoracic interventions.
It should be noted that this type of physiotherapy does not serve to replace medical treatment. Its objective is to complement it and improve its efficacy, reducing the need and amount of medication that the patient must take.
What does it consist of?
There are several respiratory physiotherapy techniques:
- Postural drainage. This is the preferred and best tolerated technique to eliminate secretions. The objective is to get the secretions to drain by the action of gravity towards the major bronchi, the trachea, and to expel them with coughing. To perform postural drainage, the patient is placed in the appropriate position, depending on the area of the lung to be drained. Thus, the patient is usually placed in the lateral decubitus position and in a sitting position. Before starting the technique it is important that the patient knows how to cough and breathe deeply. It should not be performed when the patient has recently eaten.
- Thoracic expansion exercises. These are performed with sustained maximal inhalations with a brief apnea at the end. They are followed by a slow, passive expiration. Crying and laughter are also used with young children.
- Breath control, diaphragmatic breathing. This consists of periods of slow breathing with relaxation of the accessory respiratory muscles, plus ventilation with the diaphragm. This is interspersed with more active techniques, to allow recovery and avoid patient exhaustion.
- Thoracic percussion. These are repeated tappings. In infants it is done with the fingertips, in children with the hollow hand or with an inflatable mask in the different areas of the thorax.
- Thoracic vibration. The hands or fingertips are placed on the thoracic wall and, without removing them, a vibration is generated with exhalation. This technique is combined with compression and postural drainage. The objective is to mechanically dislodge thick secretions adhered to the bronchial walls.
- Thoracic compression. Makes breathing easier by compressing the rib cage with a hug. This applies pressure on the sternum and the lower and lateral portions of the thorax. In infants, however, pressure is applied with the palms of the hands to the lower, anterior and lateral region of the rib cage.
- Provoked and directed cough. Normally, when mucus is dislodged from the wall, it triggers the cough. If this does not occur, cough can be provoked by applying slight pressure on the trachea, in the suprasternal fossa, at the end of inspiration. In this way, coughing allows expectoration of mucus through the mouth, or its swallowing. In intubated patients or patients with tracheostomy tubes, suction is used instead of coughing, by inserting a tube into the endotracheal tube.
Preparation for respiratory physiotherapy
As soon as the patient comes to the respiratory physiotherapist, he/she will perform:
- Anamnesis, to assess dyspnea, pain, expectoration, etc.
- Assessment of the dynamics and statics of the thoracic cage, visual and manual, as well as the mode and rhythm of breathing.
- Exhaustive auscultation of the patient and his respiratory sounds, important for the functional diagnosis.
- Assessment of the respiratory musculature.
- Special assessment procedures, such as spirometry, to determine basic ventilatory parameters.
- Pulse oximetry assessment, if necessary, to assess the degree of oxygen saturation in the blood.
- Stress or gait test, to provide information on the physiological adaptation of the organism to an external muscular load.
- Complementary tests: blood gas analysis, X-rays…
It is important that, at the time of the respiratory physiotherapy exercises, the patient comes without having eaten for the previous two hours, to avoid possible vomiting or gastroesophageal reflux.
Respiratory physiotherapy consists of techniques that, in principle, should be completely harmless to health, so no specific aftercare is required.