ActiveBody E DI T E D BY K AT E M A X I M
Cough it all up Many of us hadn’t realised that physiotherapists play a big part in the recovery and treatment of lung ailments, Sarah Babbs enlightens us
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OST OF US think of physiotherapy as being part of recovery and rehabilitation following injury or pain. When I was at school thinking about careers, when physiotherapy was suggested I thought exactly that. It was only when I did some research that my eyes were opened. And the first part of my career was based in respiratory roles and specialist hospitals. The role of physiotherapy is playing a big part in the fight against coronavirus. Respiratory physiotherapy involves caring for those with underlying lung disease such as cystic fibrosis, bronchiectasis and COPD, as well as following surgery or long term bed rest especially in IT situations. In all of these cases patients may have di culty breathing well, clearing their chests of sputum and managing their day to day fitness. In IT where ventilators are helping people breathe, the patient is unable to do these things for themselves. Cystic fibrosis is a genetic condition where sticky secretions build up in the lungs and restrict normal breathing. If left unattended infection can occur. ost people with cystic
fibrosis perform a daily routine including breathing exercises, positioning of the body using gravity to aid the draining of secretions and sometimes clapping which involves clapping hands against the chest to loosen secretions followed by a specific routine to clear them. An arduous task. With COPD and other causes of breathlessness, respiratory physiotherapy may involve teaching people to be more relaxed in their breathing and to change their breathing rate for tasks such as climbing stairs, in much the same way as runners do when pacing themselves. During the current Covid outbreak physiotherapists are working in IT but in a slightly different way. It appears that most people have a non productive cough, with little or no secretions to clear. Coughing can be exhausting, leading to an increase in tiredness in an already fatigued patient. Working with patients still involves the breathing work but a discovery has been made that lying prone on your front helps to improve the ventilation or air flow to the largest part of the lungs which sit low and
towards the back of the rib cage. entilated patients are being turned about every two hours which re uires a team of seven people. It seems incredible but ventilated patients are often helped to sit up on the side of the bed and sometimes are even walking with staff to promote early recovery and prevent further loss of strength and mobility. This also continues once off ventilator support and moved to the rehabilitation wards. We physios never let our exercises go As people recover from more severe Covid the main di culties seem to be fatigue, breathing di culties and confusion as well as anxiety and general weakness. upporting patients as they recover is paramount and community support is being improved to help patients once home. There has been a widely shared video of a doctor discussing how to breathe to improve ventilation and prevent further problems. e advocates taking six large breaths and then coughing. Though this may be appropriate for some, many will become di y doing this and the coughing is not necessary for most. The Association of Chartered Physiotherapists in Respiratory Care has suggested that while the exercises should be harmless for healthy individuals, they could make symptoms worse in someone suffering breathlessness. Taking 3 breaths is plenty and if one has secretions that need clearing, rather than coughing try a small huff (a small breath in and a slightly faster one out, as if trying to breathe onto a mirror). If there are secretions this moves them up the airway and a smaller cough will clear them, preventing fatigue. Then a few normal breaths to settle down. Also do them sitting in case you feel di y itting leaning forward in a chair also opens the back of the ribcage and for some with underlying respiratory conditions lying prone for a short while may be helpful. But there is no evidence that doing this will prevent healthy individuals from catching the virus, nor improve their lungs. We know that doing regular exercise which gets us out of breath helps the lungs, heart and general health, all of which may help if we become ill. o keep fit, eat well, drink plenty of water and stay well and safe. To make an appointment with Sarah ring 01780 480899 or 07780 900201
30 June 2020 / the activemag.com
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