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COPD- Role of Physiotherapy

Physical Therapy can help in curing the COPD patients

According to GOLD “Chronic Obstructive Pulmonary disease is a common, preventable and treatable disease and is characterized by persistent respiratory symptoms and airflow limitation. Approximately, 4 million deaths occurred in 1999 from tobacco and it is also estimated that the annual number of deaths is likely to increase to 10 million by the 2030s. Smoking gives a feeling of pleasure as the inhaled substances trigger chemical reactions in nerve endings in the brain, which are similar to naturally occurring substances like endorphins and dopamine.
Cigarettes constitute various harmful substances like Nicotine which leads to smoking causing various diseases like COPD (Chronic obstructive pulmonary disease). COPD describe progressive lung diseases including emphysema and chronic bronchitis. Other causes for COPD are occupational exposure, genetics, air pollution or auto-immune disease. This may lead to wheezing, frequent coughing with or without sputum, increased breathlessness, reduced endurance of respiratory muscles and tightness in the chest.
To diagnose the COPD spirometry is a simple, non-invasive test that is used to diagnose COPD. It is a test to know how well your lungs work. People with COPD have an FEV1/FVC ratio of less than 70%. Chest X-ray, Arterial blood gas report can also be used for the diagnostic purpose. For managing COPD, bronchodilators, anti-inflammatory, antibiotics, supplemental oxygen, etc., are used.
Physiotherapy plays an important role in treating the symptom of COPD specially Dyspnea. Pulmonary rehabilitation programs are designed to improve lung function, reduce symptom severity and improve quality of life. Therefore, therapeutic interventions are required to improve exercise ability and breathing by augmentation of respiratory muscle function.
The aim of breathing exercise interventions is to improve strength, endurance, and coordination of respiratory muscles. Breathing exercises are designed for the following:

  • To restrain the muscles of respiration
  • To mobilize secretions
  • To increase the effectiveness of coughing
  • To improve ventilation
  • Helps in spine correction
  • To improve chest mobility
  • To prevent impairments and promotes relaxation

Deep breathing exercise can reduce the work of breathing by decreasing the respiratory rate and relaxing accessory muscles. Strength and endurance of respiratory muscles can be improved by various breathing exercises such as Pursed-lip breathing, Diaphragmatic breathing, Glossopharyngeal breathing, and Costal breathing.
One of the most effective technique viz. Inspiratory muscle training is also commonly used to treat the symptoms of dyspnea, it helps in strengthing of the muscles involved in inhaling and is recommended in combination with aerobic and limb strengthening exercises.  IMT improves inspiratory muscle strength and endurance, functional exercise capacity, dyspnea and quality of life.
Muscle strength can be enhanced through three-dimensional spiral large scale resistive exercises using proprioceptive neuromuscular facilitation (PNF) indicated by a study which was conducted by Dietz. Chest PNF exercise is an effective and established treatment tool. It provides proprioceptive feedback to the respiratory muscles which create reflex respiratory movement responses and improves rate and depth of respiration.
Indications for Chest PNF are the following:

  • Breathing problems (inspiration or expiration)
  • Chest mobilization
  • Trunk and shoulder mobility
  • Active recuperation after exercise
  • Relief of pain
  • Relaxation
  • Decrease spasticity

Stretch reflex is used to facilitate the initiation of inhalation and Repeated Contractions are used to facilitate an increase in inspiratory volume. For breathing control, isotonic contractions are also useful. The patient should do breathing exercises in all positions which include:

  1. Supine
  2. Prone
  3. Side-lying
  4. Prone on elbows

Dr. Shivangi Sachdeva
MPT(Cardiopulmonary)

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