Respiratory Treatment: Goals and Management

• Respiratory treatment includes evaluation and therapy for individuals with acute and chronic lung conditions
• Therapeutic actions aim to be either curative or preventative

Proper Patient Management Requirements

• Understanding the physiological problem
• Measuring the effectiveness of treatments using specified criteria, like secretion accumulation

Clinical Problems of Pulmonary Disorders

• Impaired ventilation and oxygenation
• Increased work of breathing
• Elevated oxygen consumption
• Impaired Cough
• Impaired airway clearance
• Musculoskeletal dysfunction and postural abnormalities
• Decreased exercise tolerance
• Pain

Goals of Respiratory Treatments

• Goals are divided into both short and long-term objectives to be discussed with the patient
• Aim to prevent pulmonary impairment
• Improve ventilation
• Increase oxygenation
• Improve the strength, endurance, and coordination of respiratory muscles
• Reduce work of breathing
• Improve cough effectiveness
• Prevent airway obstruction and accumulation of secretions
• Improve airway clearance
• Prevent or correct postural deformities associated with respiratory disorders
• Improve endurance and general exercise tolerance
• Promote relaxation physically and mentally
• Maintain or improve chest mobility
• Decrease oxygen consumption
• Teach patients how to handle attacks of shortness of breath
• Overall improve a patient's functional capacity
• Improve the quality of life for patients

TTT to Increase Ventilation and Oxygenation

• Alveolar ventilation relies on the magnitude of tidal volume and dead space
• Tidal volume refers to the volume of air inspired and expired with each passive breath
• Dead space is the volume of gas in the lungs not undergoing gas exchange
• Normal alveolar ventilation = (500-150) * 12 = 4200 ml/min
• Alveolar ventilation formula: (VT - DS) * R.R
• Administering strategies to increase ventilation includes increasing tidal volume and decreasing dead space
• It can also include decreasing the arterial carbon dioxide tension (PaCo2) and increasing the arterial oxygen tension (PaO2)

Techniques to Increase Ventilation and Oxygenation

• Positioning exercises to improve v/q matching
• Breathing exercises

Monitoring Treatment to Improve Ventilation and Oxygenation

• Normalization of respiratory rate and pattern
• Arterial blood gases should show an increase in PaO2 and a decrease in PaCO2

Decreasing O2 Consumption

• Two approaches exist: reducing the work of breathing and reducing general body work

Reducing Work of Breathing

• Use breathing exercises and leaning forward postures
• It reduces the rate of breathing and eliminate the use of the accessory muscles

Reducing General Body Work

• Relaxation therapy
• Work adjustment
• All treatments aim to reduce the basal metabolic rate, minimize unsupported body positions, and minimize antigravity work

Benefits of Reducing O2 Consumption

• Increased dyspnea threshold for a given activity
• Increase functional activity tolerance
• Improved quality of life

Methods to Improve Secretion Clearance

• Cough technique
• Postural drainage and its adjunctives
• Active cycle of breathing
• Autogenic drainage
• Devices like flutter devices

Improving Exercise Tolerance

• Addresses muscle shortening and postural problems using stretching

Positioning Techniques

• Includes supine, prone, and lateral decubitus positions
• Changes in position can alter arterial oxygenation significantly
• Ventilation and perfusion (V/Q) ratio are factors when changing a patient's position
• At the alveolar capillary level, ventilation and perfusion must be balanced for optimal gas exchange
• Optimal V/Q ratio=1, however, there are regional differences in ventilation and perfusion across the lung areas, making the actual ratio 0.8
• Gravity and intrapleural pressure gradients cause the differences, with more negative pressure at the top of the lung and less negative pressure at the bottom
• The posterior aspects of the lungs are most gravity-dependent in the supine position and receive the most blood
• On standing, the base of the lungs is affected by gravity and has the greatest blood flow
• The area of greatest ventilation changes depending on the position

Breathing Exercises

• They retrain respiratory muscles, improve ventilation and oxygenation, and facilitate deep breathing
• They often stimulate the cough reflex, benefiting patients with acute and chronic lung disease
• These exercises involve controlled breathing activities that lessen breathing workload and improve efficiency; can include active ROM exercises
• Acute or chronic lung disease, thoracic/abdominal pain due to surgery/trauma, airway obstruction, CNS (neuromuscular) deficits, scoliosis/kyphosis affecting respiratory function, stress, and old age/bed rest are all possible candidates for this treatment

Breathing Exercise Goals

• Improve ventilation function to improve tidal volume
• Improve strength, endurance, and coordination of respiratory muscles
• Increase effectiveness of cough mechanism
• Aid in the removal of secretions
• Prevent atelectasis
• Correct ineffective or abnormal breathing patterns
• Improve the position and function of respiratory muscles
• Control the breathing rate and pattern (decrease air trapping)
• Maintain or improve chest mobility through the spine
• Promote relaxation by reducing the work of breathing

General Principals in Teaching Breathing

• Choose a quiet space for instruction
• Explain the aims and rationale
• Ensure patient is comfortable, relaxed, and unrestricted
• Position patient in bed with head and trunk lifted 45 degrees, hips and knees flexed, or alternatively, in supine, sitting or standing positions
• Observe and evaluate their breathing pattern when active or inactive, and determine is retraining is required
• Determine where to focus the exercise program, either inspiratory or expiratory
• Set up a baseline to track treatment progress and change
• Teach the patient relaxation techniques to minimize the use of upper accessory muscles and reduce tension

Techniques and Movements

• Demonstrate the breathing pattern that is requested to the patient
• Ask patient to practices in a variety of rest vs activity postions
• Guidance is used to stimulate the chest movement and "guide the motion," preventing trick movement
• Assistance involves pressure at the end of the expiratory phase
• Mobilization mobilizes thoracic joints via the ribs while giving pressure and vibration at the end of expiration
• Strength trains the intercostal muscles, resisting movement of the chest by pressure at the mid-inspiration point
• After showing proper methods, the patient can do the exercise by themselves

Breathing Exercise Precautions

• Avoid forced expiration, which can reduce airway restrictions leading to bronchospasm.
• Do not let the patient overdo exhalation, which will result in them panting.
• Stop patient from initiating breath with chest that is accessory
• If not, should happen, the upper chest part will quiet
• Practice three deep breaths for practice, to avoid hyperventilation
• Voluntarily control deep patterns of breathing in a relaxed state

Contraindications to Breathing Exercises

• Severe pain/discomfort
• Cases of acute trauma/surgery
• ICP and reduced consciousness
• Injury and instability in the head and neck
• Bony metastases, brittle bones, bronchial hemorrhage, and emphysema
• Skin grafts/Spinal Fusions
• Anticoagulation
• Asthma and TB
• Recent history of heart attack
• Pneumothorax

Types of Breathing Techniques

• Normal breathing or 'breathing control = minimal effort is expended.
• Breathing exercises - Either inspiration = emphasized as in thoracic expansion or expiration = emphasized as in the huff of the forced expiration.
• Diaphragmatic breathing exercise
• Pursed lips breathing exercise
• Segmental (localized ) breathing exercises
• Belt breathing exercise
• Sustained maximal breathing exercise
• Breathing exercise connected wit postural exercise
• Breathing control techniques (paced breathing)

Other Breathing Classifications

• Inspiratory exercise - Nose exercise, Diaphragmatic breathing, Localized breathing exercise (Segmental breathing), Belt exercise
• Exercises to strengthen inspiratory muscles, and help increase the depth of inspiration, helping inspiratory resistance
• Expiratory exercise - Pursed lip breathing, Buteyko breathing technique, Active cycle of breathing technique, Autogenic drainage, Candle blowing, Talking long sentences, Forced expiratory technique
• Postural exercises assist when coupled with breathing, For both inspiration and expiration

Nose Breathing Exercises

• Helps to stimulate and strength for both diaphragm and Graduations
• Give a massage for the nose, for both sides for stimulation
• Feeling the air on the top of nose
• Giving him something to smell
• Vibrate of the nose to stimulate the normal airway passage by using the middle & ring finger bilaterally
• Close one opening, then open it up to take inspiration and expiration
• Inspire from a new opening and expire, is the new open will start to close
• Do snuffing to stimulate diaphragm and sniff deep through the lung to strength
• Massage the nose with relaxation

Diaphragmatic Breathing

• Patient, although breathing via an involuntary level, is instructed to perform through correct use of the diaphragm and relaxation

Diaphragmatic Breathing Benefits

• Improve Diaphragmatic excursion, distribution of ventilation (expansion) to lung zones in the lower portion
• Increase total ventilation, elimination of muscles and improvement in rib cage movement
• Should be used for control to attack exersion and assist oxygen/air intake, to mobilize lung portions, and delay fatigue

Tips For Diaphragmatic Breathing

• Place patient/hand on epigastric area (On rectus abdominis just below the anterior costal margin
• Breath deeply and slowly to the relaxing area to help with and rise (keep shoulder relaxed in the process)
• Take a breath, and abdomen should be allowed to expand
• Breath through the nose, while the mouth is closed

Diaphragmatic Breathing Weight and Caution

• Diaphragm strength can be assisted via patient being weight rested, with the patient being supine
• Use (1.30-2.20kg or 3-5 lbs, with sandbag over the abdomen.
• Resist going the weight, with deep breathing, and should be with each set.
• PT can help assist resistance, with the patient knowing how to breath using the area correctly

Pursed Lips Breathing Technique

• Slow down R.R , reduction in expiration , and increase tidal volume
• Enhance ventilation can be help with areas that are not ventilated/inflated
• A strong help and prevent of the collapsing in the airways
• Can be help in the COPD and shorts of asthma

Pursed Lips - Guidance

• Sit down, with the area as relaxed and comfortable to support diaphragmatic expansion to breath
• Inhale slow and deep and nose to breath
• Breath through the nose, slowly
• Make twice and go back through to exhaling

Segmental Breathing And Benefits

• Localized portions and increase with chest movement, to assist in area
• Expand the portion of the lungs and prevent accumulation in the tracheobrancial
• Apical, lateral breathing is helpful

Apical Breathing Guide

• Helpful when restricted upper movement
• The patient will breathe, going forward again the finger
• Half-lying while flex, with pillowed lower legs, or sitting to assist the muscle Apply pressure just under both clavicles during breathing

Lateral Costal and Guidance

• Therapist hand should be where knuckled, a bit of angle and to the side
• To help mobile and strength to keep that way on the ribs
• Patient to push to keep hands to chest with air and support, assist in pushing inward

Lower Costal and Guidance

• Seated, over the area
• Thumbs will be on, and knuckles need to be parallel
• Can be quick or downward to where the limbs are held

Assisted Breathing via Basal and Sternal portions

• Patient needs to hold a area, slightly bend
• Segmenting, should have a form, to hold secretions up

Belt vs Breathing with belts

• Is a case of being used for where issues can happen and support
• Used mostly in incisions, which makes pressure applied
• Good for folks with a certain level of fat or operations
• Helps equal equal the pressure and easy.

- Sustained vs Breathing control

• Slow the portions via the hold, typically for about 3 seconds as the inspiration
• Steps for breathing is in steps, and pulling is exhaling and sitting is exhaling

Breathing with Trunk vs Control

• Should be combined when issues affect
• Muscle and mobilization and strong, to help with movement
• Limb to move the parts (flexion and reduction
• Breathing can be connected to Bending vs Rotation

Exersice can help in mobilization of tight and long

• Progress in the high arm can help
• Bend forwards and have arm over the shoulder
• With both, breath slowly

Buteyko technique is focused on what

• Focuses to exhale with hyper and anixity, asthma issues

Buteyko technique - method

• Measures CO2 through exhale, to keep control and pause during it
• Should be avoided for the areas with a large host of issues, which is a need
• Take pulse while you breath in at the wrist and keep the measure and hold it

Glossopharyngeal breathing, for respiratory assist

• Used in reduced in the areas where the cord is
• Assist high levels, and improve areas
• Maintain wall and improve it
• Be able to use ventilation, if the area is damaged more than sleep
• Produce action through the valve

Strelnikova Breathing uses what

• It compresses the area to stimulate and use air resistance to create
• It stops hyper and prevents, it
• Types are with the shoulder and rotation, etc

Respiratory muscle trainers

• Devices help in area
• To increase and test and select patient area
• Will increase the pressure

The incentive process and training is what technique

• This will to improve muscles and the strength to get ventilation
• They will breath normally in a high level of the area If they take 3 to 4 normal deep cycles, that the pt will be asked

Muscle and resistance - technique

It avoid the muscle to work

Frolov’is device help what

• Provides a set of feature and healing of the areas, that is well known in the areas of function.
• Device cup is the internal use

Benefits to this is what

• Muscles fatigue and gas exchange to help areas
• Reduce in areas of pain
• Quality will be assisted

What about Power lungs technique

• Assist in the muscles to work with better effort

Expand -A-Lung will do what

• Help boost and assist the respiratory
• Increase lung and the amount of breaths in efficiency
• Strengthen the overall muscle process

What steps, and testing would assist to have relaxed therapy

1. Patients should lie on supportive equipment, while reducing tension
2. Inspect and be palpation to test tone
3. Allow for passive movement, and rest
4. Use sleep for a test of comfort Breath in and use air, which will lead to tense and the body

Physique Relaxation, - What do they do

A. General - B. Local How to gain relaxation will involve laying down a area that will need a position Such and standing, with the chair Suspension , and Massage

List of Bronchosm - will involve what

• Butyeko breathing and lip pursing
• Frolov’s training
• Osteo and Power
• Use of Expansion and posture of relaxing