Respiratory problems are very commonly present in hospital settings, with a wide variety of diagnoses being assessed and treated by physiotherapy. Most common conditions include pneumonia, chronic bronchitis, asthma, bronchitis, cystic fibrosis, hyperventilation and chronic obstructive pulmonary disease. Physiotherapists are trained to assess respiratory conditions and manage, treat and advise on them. Respiratory skills are an important part of every physiotherapist’s training and early work, if they have a job in an acute area of practice. It is a difficult skill to learn and physiotherapists have a lot of responsibility for managing acutely unwell patients in hospitals.

The physiotherapist will begin the assessment by reading the patient’s observation charts and medical notes to familiarize themselves with the doctor’s treatments, diagnosis and prognosis. The physiotherapist will be familiar with the usual values for the typical respiratory blood tests. The physiotherapist introduces themselves and asks the patient about their illness whilst observing the patient to acquire useful information. The effort the patient makes to breathe, the use of neck or arm muscles to help make breathing easier, the patient’s weight, how well they look, the rate per minute of their breaths, the use of treatments such as oxygen, the colour of the extremities and the face, all these things give useful information and help with the objective examination.

Having gathered a lot of information very efficiently by observation the physiotherapist can then decide what form the objective examination should take. The patient’s lung expansion and air entry are assessed by the physiotherapist feeling the rise of the ribs with their hands and deciding if it is normal and the same on both sides. Listening to the chest via stethoscope indicates the status of air entry to the peripheral airways, whether there are any areas of consolidation, collapse or bronchospasm giving wheeze. This part of the assessment will indicate how much further investigation is needed and what treatments might be indicated.

Initial treatment concentrates on deciding whether the patient is getting the correct concentration of oxygen. If the patient’s oxygen saturation is low then oxygen could be prescribed at a particular percentage such as 24% or 28% through a specific device which ensures the correct percentage. The correct oxygen level is extremely important to maintain before any other treatments are attempted as too much or too little oxygen administration can be harmful. Due to the drying effects of constant gas delivery the oxygen should be humidified through a system which heats the gas as it humidifies it.

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.