1.1 The scope of respiratory physiotherapy

Patients with respiratory problems are encountered in many different settings, from long-term care in the community to critically ill patients on an intensive therapy unit (ITU) (also known as critical care) (Figs 1.1–1.3). Respiratory care may be an integral part of the patient’s management in secondary care (hospital) settings, such as respiratory, medical, and surgical and orthopaedic wards as well as burns, care of the elderly, paediatric, neurological, neurosurgical and oncology units. It may also be required for patients with mental health problems or learning disabilities. Physiotherapists work in many of these settings and also within primary care (in the community) for the longer-term rehabilitation of these patients. They may be employed in multiprofessional ‘rapid response’ or ‘early discharge’ teams, in which they share the responsibility for assessing and managing acutely ill patients in their own home.

Fig 1.1 Patient with chronic obstructive pulmonary disease at home with oxygen.

Fig 1.2 Pulmonary rehabilitation.

Fig 1.3 The intensive therapy unit (critical care) setting.

This book will cover physiotherapy assessment in any of the above settings. It is recognized that our role with many respiratory patients may be directed more towards function and rehabilitation than towards specific respiratory problems. Although the focus of this book will be on the assessment of the cardiovascular and respiratory systems, the checklists and tools also include reference to some generic assessment procedures (e.g. functional assessment) and aspects of musculoskeletal and neurological assessment (e.g. pain assessment and muscle testing); however, these have not been considered in detail and the reader is directed to other books in the toolkit series for further information.

The case history in Box 1.1 illustrates the scope of respiratory physiotherapy.

Box 1.1

Bob Fleming is a 68 year old man with chronic obstructive pulmonary disease who presented to his GP with a chronic productive cough and shortness of breath; he was referred to an outpatient physiotherapist, who taught him some strategies for airway clearance.

At this point, it was noted that he had slowly declining exercise tolerance, and so was referred on to the community pulmonary rehabilitation team. This improved his exercise tolerance, reduced his breathlessness and he was delighted.

Two years later he had his first significant exacerbation of his disease, and was admitted to hospital via the emergency department. He developed type II respiratory failure and was commenced on non-invasive ventilation and transferred to a critical care unit. The medical ward physiotherapist assisted in the setting up and monitoring of his non-invasive ventilation.

Although, initially, he improved, later that day he deteriorated to the point where he required intubation and invasive ventilation. His respiratory status and early rehabilitation were managed by the critical care physiotherapist.

From critical care he was discharged to a respiratory ward, where his therapy continued. He was given an early discharge, requiring regular observation and review; therefore, he was placed in the care of the early discharge team, which included a physiotherapist.

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Related

Related posts:

1. Assessment checklists
2. Case scenarios
3. Assessment tools
4. Pleural Effusion Due to Parasitic Infection

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