Respiratory physiotherapy has been around since about 1898 when S.H. Quincke recommended intermittent postural drainage to treat patients with thick secretions. In the 1990’s the flutter device was developed to aid with mucous clearance. If a patient has a physical problems then physiotherapy is indicated (Pryor, J, 1998). Respiratory physiotherapy is both an art and a science, effectiveness depends on problem solving, evidenced based knowledge and a clear perspective of what the patient needs (A.Hough, 1996). Modern day respiratory physiotherapy is continuing to challenge the status quo and refuses to be defined by historical boundaries.
Respiratory physiotherapy is however, poorly understood by the public and most healthcare professionals. You will find respiratory physios in acute hospitals on the wards and outpatient departments as well as in the community, on rehabilitation wards and domiciliary teams. Increasingly there are community respiratory teams which are now multi disciplinary offering holistic care. We treat a huge variety of problems including obstructive and restrictive lung disease, neurological impairments of the upper and lower respiratory tract, retained secretions, increased work of breathing and reduced mobility to name a few. People still say to me “you’re a physio, I have a bad back, can I have a massage?” and I have had a respiratory consultant prescribe “drumming on the chest”. These misconceptions not only undermine the complexities of our profession but also affect how the patient values us and the treatments we recommend. The ACPRC and CSP have done much over the last few years to promote our role and now have seats in many groups such as the British Thoracic Society and NICE but these are slow to filter out and change services.
In my 10 years in the NHS I have noted many wonderful examples of holistic care and many pitfalls. This may be controversial but I do not see the NHS as a national service when each area is so different and services are commissioned so differently, not to mention the bonkers and frankly out of date IT. I appreciate each area has different populations and problems but it is not rocket science that respiratory is a growing problem, why then has it only just been brought to the fore in the NHS plan? Community respiratory teams are a must in my opinion, commissioning should not be based on diagnosis as there are many people without a respiratory diagnosis but have respiratory symptoms that physios can address. For example I have clients with profound learning disabilities, many of whom are adults with musculoskeletal deformities. It is well documented that pneumonia is the biggest cause of early mortality in this client group (LEDER, 2018). Physiotherapy can have a huge impact on reducing this and respiratory physiotherapy can support carers/parents to prevent and manage lower respiratory tract infections (LRTI) in the community. There is no specialist community service that can support this client group well enough in the community in my area, physios are great problem solvers and with commissioning support could reduce admissions of complex patients. Other physios across the country have trouble accessing community support for tracheostomy patients on hospital discharge or suction support in the community for example. This could be resolved if respiratory teams were commissioned to support all patients with any respiratory related problems in the community, supporting general practice and linking in with acute and specialist care.
Roles such as matrons/ANPs/respiratory nurses should be open to physiotherapists and other AHPs. If a physio can read a job specification and prove they tick all the boxes then they should be considered for the role rather than NHS jobs limiting it to one sector. First contact physio has rolled out from an musculoskeletal perspective into GP ‘land’ and proven to save time and money as well as provide excellent patient care without impacting upon the roles of GP’s or physiotherapists negatively. Many respiratory physiotherapists are prescribing now and can have a positive impact here, see my poster presentation at Physio UK conference in November. Consultant physio roles are developing and need more consideration too. One of the reasons I left the NHS was lack of professional development, there was nowhere to go to clinically but there was a need.
So what is the solution? Well it is not one size fits all but there needs to be more discussion with the clinicians on the ground, the worker bees. There is a huge gap in primary care that respiratory physiotherapy could fill. From a first contact perspective we can assess all LRTI patients presenting at the GP practices freeing up GP time. We can make differential diagnoses, perform diagnostic spirometry, review CXR and bloods as well as sputum samples, prescribe, ensure excellent inhaler technique, know when to refer onto more specialist services as well as the core skills such as chest clearance, breathless management, exercise and cough control. Respiratory teams need to cross primary and secondary care, truly integrating, multidisciplinary roles with consultant support need to be developed and not be defined by diagnosis.
Pryor, J.A. & Webber, B.A. (1998) Physiotherapy for Respiratory and Cardiac Problems. Hough, A (1996) Physiotherapy in Respiratory Care: An evidence-based approach to respiratory and cardiac management. Third Edition.
ACPRC https://www.acprc.org.uk/BTS https://www.brit-thoracic.org.uk/CSP https://www.csp.org.uk/
The Learning Disabilities Mortality Review (LeDeR) Programme. Annual report 2018: https://www.hqip.org.uk/resource/the-learning-disabilities-mortality-review-annual-report-2017/#.XXXwf-zTU
This was an article I wrote and was published in the Respiratory Show Magazine 2019