Respiratory physiotherapy: towards a clearer definition of terminology

Deep breathing exercise at work: Potential applications and impact

Hypertension is a major contributor to cardiovascular disease and daily deep breathing exercise (DBE) is a promising intervention to reduce blood pressure and stress in adults. DBE is simple, time-efficient, and does not require specialized equipment, allowing participation in a wide variety of settings. The workplace is an ideal setting to implement DBE at the national level for several reasons, including a large proportion of waking hours spent in the workplace, high levels of sedentary time at work, prevalence of work-related stress, and regular breaks throughout the day potentially reducing worker error. While the degree of adherence to daily workplace DBE will be the responsibility of the individual, employers and managers can (and should) do much to remove barriers to participation. Specifically, this could include: implementing regular short breaks or classes to perform DBE throughout the day, covering subscription costs for smartphone applications that guide DBE, and creating incentive programs for continuing DBE participation. Implementing DBE in the workplace is a pragmatic approach to provide a low-cost blood pressure and stress reduction therapy to a substantial portion of the adult population in the US, at least 50% of whom have high blood pressure.

Effects of Diaphragmatic Breathing on Health: A Narrative Review

Background: Breathing is an essential part of life. Diaphragmatic breathing (DB) is slow and deep breathing that affects the brain and the cardiovascular, respiratory, and gastrointestinal systems through the modulation of autonomic nervous functions. However, the effects of DB on human health need to be further investigated. Methods: The author conducted a PubMed search regarding the current evidence of the effect of DB on health. Results: This review consists of a total of 10 systematic reviews and 15 randomized controlled trials (RCTs). DB appears to be effective for improving the exercise capacity and respiratory function in patients with chronic obstructive pulmonary disease (COPD). Although the effect of DB on the quality of life (QoL) of patients with asthma needs to be investigated, it may also help in reducing stress; treating eating disorders, chronic functional constipation, hypertension, migraine, and anxiety; and improving the QoL of patients with cancer and gastroesophageal reflux disease (GERD) and the cardiorespiratory fitness of patients with heart failure. Conclusions: Based on this narrative review, the exact usefulness of DB in clinical practice is unclear due to the poor quality of studies. However, it may be a feasible and practical treatment method for various disorders.

Low-Cost Joystick for Pediatric Respiratory Exercises

The use of body signals for health care applications has become ubiquitous in the last decade. One utilization of such measurements is the monitoring of respiratory flow for physiotherapy assistance. This application is based on relative flow measures which can rely on inexpensive sensors. Based on that, we present a low-cost electronic device that detects blows and suctions with a pressure sensor and emulates a keyboard for interfacing with computers. This joystick allows children to control free internet games by associating blows and suctions with different intensities to keyboard actions. Also, the intensity can be calibrated according to the user’s pulmonary capacities. This feature is adequate for gradual respiratory physiotherapy and can be customized for each patient. In order to verify the operation of the proposed device, practical tests were performed with three online free games, where the joystick functionality was assessed with different therapeutic configurations.

Breathing exercises for adults with asthma

Asthma is a common long-term condition that remains poorly controlled in many people despite the availability of pharmacological interventions, evidence-based treatment guidelines and care pathways.(1) There is considerable public interest in the use of non-pharmacological approaches for the treatment of asthma.(2) A survey of people with asthma reported that many have used complementary and alternative medicine, often without the knowledge of their clinical team.(3) Such interventions include breathing techniques, herbal products, homeopathy and acupuncture. The role of breathing exercises within the management of asthma has been controversial, partly because early claims of effectiveness were exaggerated.(4) UK national guidance and international guidelines on the management of asthma have included the option of breathing exercise programmes as an adjuvant to pharmacological treatment.(5,6) Here we discuss the types of breathing exercises used and review the evidence for their effectiveness.

Air pollution is associated with primary health care visits for asthma in Sweden: A case-crossover design with a distributed lag non-linear model

BACKGROUND

Air pollution can increase the symptoms of asthma and has an acute effect on the number of emergency room visits and hospital admissions because of asthma, but little is known about the effect of air pollution on the number of primary health care (PHC) visits for asthma.

OBJECTIVE

To investigate the association between air pollution and the number of PHC visits for asthma in Scania, southern Sweden.

METHODS

Data on daily PHC visits for asthma were obtained from a regional healthcare database in Scania, which covers approximately half a million people. Air pollution data from 2005 to 2010 were obtained from six urban background stations. We used a case-crossover study design and a distributed lag non-linear model in the analysis.

RESULTS

The air pollution levels were generally within the EU air quality guidelines. The mean number of daily PHC visits for asthma was 34. The number of PHC visits increased by 5% (95% confidence interval (CI): 3.91-6.25%) with every 10µg m(-3) increase in daily mean NO2 lag (0-15), suggesting that daily air pollution levels are associated with PHC visits for asthma.

CONCLUSION

Even though the air quality in Scania between 2005 and 2010 was within EU's guidelines, the number of PHC visits for asthma increased with increasing levels of air pollution. This suggests that as well as increasing hospital and emergency room visits, air pollution increases the burden on PHC due to milder symptoms of asthma.

A taxonomy of voice therapy

PURPOSE

Voice therapy practice and research, as in most types of rehabilitation, is currently limited by the lack of a taxonomy describing what occurs during a therapy session (with enough precision) to determine which techniques/components contribute most to treatment outcomes. To address this limitation, a classification system of voice therapy is proposed that integrates descriptions of therapeutic approaches from the clinical literature into a framework that includes relevant theoretical constructs.

METHOD

Literature searches identified existing rehabilitation taxonomies/therapy classification schemes to frame an initial taxonomic structure. An additional literature search and review of clinical documentation provided a comprehensive list of therapy tasks. The taxonomy's structure underwent several iterations to maximize accuracy, intuitive function, and theoretical underpinnings while minimizing redundancy. The taxonomy was then used to classify established voice therapy programs.

RESULTS

The taxonomy divided voice therapy into direct and indirect interventions delivered using extrinsic and/or intrinsic methods, and Venn diagrams depicted their overlapping nature. A dictionary was developed of the taxonomy's terms, and 7 established voice therapy programs were successfully classified.

CONCLUSION

The proposed taxonomy represents an important initial step toward a standardized voice therapy classification system expected to facilitate outcomes research and communication among clinical stakeholders.

Nonpharmacological interventions for refractory chronic cough patients: systematic review

BACKGROUND

For people with refractory chronic cough, nonpharmacological interventions are emerging as alternatives to antitussive medications. These treatments generally are delivered by physiotherapists and speech and language therapists and consist of education, breathing exercises, cough suppression techniques, and counselling. Although the number of studies investigating these treatment options has increased in recent years there has not been a systematic review of the efficacy of these treatment options.

METHODS

Studies were searched for in EMBASE, AMED, Medline, CINAHL, and PsycINFO databases. Bibliographies of studies and reviews were searched by hand. Critical appraisal was carried out by one reviewer using the SIGN appraisal tools and Cochrane handbook for systematic reviews.

RESULTS

From a total of 184 studies, 5 full-text English language articles were included in the review. Nonpharmacological interventions were found to significantly reduce cough reflex sensitivity, improve quality of life, and lead to reductions in cough severity and frequency. However, few studies used validated and reliable tools to measure cough severity and frequency thereby limiting the robustness of these findings.

CONCLUSION

Present data support the use of two to four sessions of education, cough suppression techniques, breathing exercises, and counselling in order to achieve improvements in cough sensitivity and cough-related quality of life for people with chronic refractory cough. Due to the lack of validated outcome measures, results for other aspects of cough should be interpreted with caution. There is a need for additional larger-powered comparative studies investigating nonpharmacological interventions for refractory chronic cough.

Treatment taxonomy for rehabilitation: past, present, and prospects

The idea of constructing a taxonomy of rehabilitation interventions has been around for quite some time, but other than small and mostly ad hoc efforts, not much progress has been made, in spite of articulate pleas by some well-respected clinician scholars. In this article, treatment taxonomies used in health care, and in rehabilitation specifically, are selectively reviewed, with a focus on the need to base a rehabilitation treatment taxonomy (RTT) on the "active ingredients" of treatments and their link to patient/client deficits/problems that are targeted in therapy. This is followed by a description of what we see as a fruitful approach to the development of an RTT that crosses disciplines, settings, and patient diagnoses, and a discussion of the potential uses in and benefits of a well-developed RTT for clinical service, research, education, and service administration.

Cough suppression therapy: does it work?

Cough suppression therapy (CST), also known as cough suppression physiotherapy and speech pathology management is a promising non-pharmacological therapeutic option for patients with refractory chronic cough. CST may consist of education, improving laryngeal hygiene and hydration, cough suppression techniques, breathing exercises and counselling. It is an out-patient therapy delivered in 2-4 sessions. There is evidence to support the efficacy of CST: a randomised controlled trial reported a significant reduction in cough symptoms and other studies have reported improved cough related quality of life, reduced cough reflex hypersensitivity and cough frequency. The mechanism of action of CST is not clear, but it has been shown to reduce cough reflex sensitivity, paradoxical vocal fold movement (PVFM) and extrathoracic hyperresponsiveness. Further research is needed to determine the optimal components of CST, the characteristics of patients in whom it is most effective and to increase the understanding of its mechanisms of action. The effectiveness of CST in other respiratory conditions such as asthma, pulmonary fibrosis, chronic obstructive pulmonary disease and sarcoidosis should also be investigated.

Correlation between perceived asthma control and thoraco-abdominal asynchrony in primary care patients diagnosed with asthma

OBJECTIVE

Thoraco-abdominal asynchrony (TAA), the discordant movement of the abdomen and thorax, may impact upon health-related variables. Here, we investigated the extent to which TAA is associated with health-related variables, particularly perceived asthma control and quality of life.

METHODS

Ambulatory respiratory data from 43 patients diagnosed with asthma and 43 healthy age and sex-matched controls were recorded over 4 hours. Phase relation (Ph Rel Total), the percentage of time that the effects of rib cage (RC) and diaphragmatic movement result in opposite effects on intra-thoracic volume, quantified TAA. Subjects completed the Mini Asthma Quality of Life Questionnaire (AQLQ), Asthma Control Questionnaire (ACQ), Nijmegen questionnaire (NQ), Hospital Anxiety and Depression Scale (HADS), Spielberger State-Trait Anxiety Inventory (STAI), and General Health Perception (GHP) subscale of the short form 36 questionnaire'. Capnography profiling, breath-hold time (BHT), and standard spirometry were performed.

RESULTS

The time in asynchrony was significantly greater in the asthma than in the healthy control group (Ph Rel Total = 14% (interquartile range (IQR) 8.5-20.7%) versus 10.4% (IQR 7.1-14.5%), p = .012). In patients with asthma, Ph Rel Total was weakly associated with poorer ACQ scores (r = 0.33, p = .03), and in the healthy control group with GHP (r = 0.319, p = .037). Post-hoc exploratory analysis revealed a moderate relationship in the female asthma subgroup between Ph Rel Total and AQLQ (r = -0.56, p = .003).

CONCLUSIONS

TAA may be associated with decreased perceived asthma control. In healthy individuals, asynchrony may be associated with low perception of general health. Further studies are required to investigate if the reduction of TAA improves these health-related variables.