Chronic Obstructive Pulmonary Disease (COPD) is a progressive disease that is characterized by airflow limitation and inflammation. Breathlessness, decreased physical activity and recurrent chest infections are some manifestations of the disease. The average age of individuals with COPD who require secondary care services in a Dublin teaching hospital is 65. Many will have smoked approximately 340,000 cigarettes in their lifetime, have three to four chest infections a year, be short of breath at rest, and demonstrate a sedentary lifestyle clocking up only 36% of the 10,000 recommended steps a day (Deering et al, 2011; Egan and Deering et al, 2012). Other symptoms of the COPD include sputum retention and cough, a weakened respiratory muscle; a muscle that helps us to breathe, and the development of altered breathing patterns all of which negatively affect the optimization of inhalation therapy which can cause re-exacerbations.
COPD Guidelines (Bott et al, 2009) promote a comprehensive physiotherapy assessment of the underlying cause of breathlessness as being fundamentally necessary in developing and selecting treatment strategies with which help to relieve this distressing symptom, to improve function, and to select and teach techniques which help improve or maintain airway clearance and prevent/resolve collapse of small airways due to sputum plugging. Physiotherapists also provide education on strategies for self-management, including smoking cessation. Advance Practice and Clinical Specialist Physiotherapists possess the necessary core competencies required to clinically monitor and address any deterioration in lung function and volume, changes in oxygen requirements, physical activity levels, quality of life and cognitive function that can change or increase risks of an exacerbation (Sulaiman et al, 2016, Cushing et al 2016).
Since 2005, physiotherapists have lead the development of COPD Outreach services in Ireland and are employed in the National Clinical Care Programmes such as, COPD Outreach, Pulmonary Rehabitation, and the Asthma/COPD Demonstrator programmes, all of which are integral to the newly developed National Model of Care for the management of COPD in Ireland.
Written by Brenda Deering, COPD Outreach Co-ordinator, Beaumont Hospital