Current developments and future directions in respiratory physiotherapy

Abstract

Respiratory physiotherapists have a key role within the integrated care continuum of patients with respiratory diseases. The current narrative review highlights the profession's diversity, summarises the current evidence and practice, and addresses future research directions in respiratory physiotherapy. Herein, we describe an overview of the areas that respiratory physiotherapists can act in the integrated care of patients with respiratory diseases based on the Harmonised Education in Respiratory Medicine for European Specialists syllabus. In addition, we highlight areas in which further evidence needs to be gathered to confirm the effectiveness of respiratory therapy techniques. Where appropriate, we made recommendations for clinical practice based on current international guidelines.

Addressing the changing rehabilitation needs of patients undergoing thoracic surgery

“…In the past two decades the focus has therefore gradually shifted to pulmonary rehabilitation interventions that aim to improve functional status of individuals, both in the pre- and (longer-term) postoperative period. 2 –4…”

“…In the past two decades the focus has therefore gradually shifted to pulmonary rehabilitation interventions that aim to improve functional status of individuals, both in the pre-and (longer-term) postoperative period. [2][3][4] Postoperative pulmonary complications (PPC) such as atelectasis, bronchospasm and pneumonia, remain the most common acute postoperative problem in this population. 5 While the way in which PPCs are defined varies enormously depending on the scoring system used, 6 they are typically defined as a "pulmonary abnormality that produces identifiable disease or dysfunction that is clinically significant and adversely affects the clinical course of recovery."…”

FisioAr I: aplicativo móvel desenvolvido para reeducação respiratória na reabilitação pulmonar

“…Dado isso, ao estabelecer um plano de tratamento direcionado para um paciente específico, espera-se que haja a adaptação dos tipos de condutas a serem aplicadas aos diferentes tipos de respiração disfuncional. Literaturas diversas atentam quanto aos distúrbios relacionados à hiperventilação, em concordância, afirmam que o recomendado para esses pacientes é que haja intervalos entre um ciclo e outro e os ciclos não devem exceder 2-3 minutos (cerca de 8-12 inalações e/ou exalações, para que se haja um melhor aproveitamento de tempo, qualidade e boa execução dos exercícios, é o que será preconizado durante a aplicação dos exercícios por meio do aplicativo (Jarosz, et al, 2020;Kader, et al, 2022;Rodrigues, et al, 2020).…”

Virtual respiratory therapy delivered through a smartphone app: a mixed-methods randomised usability study

“…Developed in the 1970s, incentive spirometers are motivational devices designed to engage patients to persist with repeated gradual maximal inspirations for respiratory therapy. 1 2 The original purpose for this therapy was encouragement to produce inspirations which mimicked a yawn or a sigh, intended to reinflate collapsed alveoli (ie, alveolar atelectasis) arising as a side effect from surgical anaesthesia or protracted periods of postoperative recuperation in bed. 3 4 Designed as a ‘bedside reminder’ for patients to practice deep inhalations, applications for incentive spirometry (ISy) therapy now encompass prevention of chest infections and pneumonia due to mucus build-up in the airways, including chronic conditions such as chronic obstructive pulmonary disease and cystic fibrosis.…”

“…Developed in the 1970s, incentive spirometers are motivational devices designed to engage patients to persist with repeated gradual maximal inspirations for respiratory therapy 1 2. The original purpose for this therapy was encouragement to produce inspirations which mimicked a yawn or a sigh, intended to reinflate collapsed alveoli (ie, alveolar atelectasis) arising as a side effect from surgical anaesthesia or protracted periods of postoperative recuperation in bed 3 4.…”