Pneumonia In Private Practice: Chest Physiotherapy, Diagnosis, Treatment, Techniques & Nutritional Support


AUTHOR: SARAH LARGE, BOUNCEREHAB PHYSIOTHERAPIST STUDENT – UNIVERSITY OF SYDNEY

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 Co-AUTHOR: MATTHEW CRAIG, PHYSIOTHERAPIST  BOUNCEREHAB

Pneumonia In Private Practice: Chest Physiotherapy, Diagnosis, Treatment, Techniques & Nutritional Support

 

Physiotherapy is most commonly associated with sports, athletes and rehabilitation of musculoskeletal injuries. However, physiotherapy is much broader than this. One particular area that frequently goes unnoticed is chest physiotherapy – also known as cardiopulmonary or respiratory physiotherapy. This is a specialized treatment that is usually seen on an acute care ward in a hospital for patients with cystic fibrosis, chronic lung disease and pneumonia.

BUT… Did you know, that chest physio treatment can be received in a private clinic outside the hospital?

 

Chest physiotherapy may be suitable for someone recovering from pneumonia and needing some assistance to clear the lungs and speed up recovery. This is something that the physiotherapists at bounceREHAB have had years of success with in Pyrmont, Sydney.

So, lets start by going back to the basics and outline what happens to someone’s lungs over the course of pneumonia infection. This will help portray a distinct connection of how chest physiotherapy can intervene and be successful in doing so.

So what is pneumonia?

Pneumonia is a lung infection caused by a virus or bacteria entering the tissue of lungs and causing inflammation. The inflammation progresses and results in the tiny air sacs in our lungs becoming filled with pus and fluid, known as consolidation – this is the body’s mechanism of trying to fight the infection.

Common signs and symptoms include:

Figure 2: How pneumonia affects our body

Figure 2: How pneumonia affects our body

  • difficulties breathing
  • fever or chills
  • loss of appetite
  • abdominal pain
  • headache
  • chest pain
  • cough
  • blue coloration of the skin surrounding the mouth (cyanosis)

 

 

The natural history of pneumonia can be broken into two specific phases:

Phase 1: Consolidation 

XRAY Pneumonia

Figure 3: XRAY example of left sided consolidation

This phase involves the body’s reaction to the bacteria or virus in the body which stimulates the inflammatory response. This involves the capillaries becoming larger and causing an increase in blood flow to the area which subsequently results in the lung tissue becoming stiffer and harder to expand, hence physiotherapy initially is not indicated. During this phase the patient most commonly suffers from a dry cough and shortness of breath. This phase generally lasts for 7-10 days.

Figure 3: Mucus build up within the lungs

Figure 4: Mucus build up within the lungs

Phase 2: Resolution 

This phase is where the body has an influx in the production of infection fighting factors known as neutrophils, lymphocytes and macrophages which all work together to kill the virus. Through the process of breaking down the pathogen a by-product of pus and mucus is created. During this process there is an increase in the amount and thickness of the sputum produced, resulting in a moist strong cough with generally sticky secretions that are hard to clear. Hence, during this phase chest physiotherapy can be of great benefit to loosen and eliminate excessive secretions.

Diagnosis 

Pneumonia is usually diagnosed by identifying signs and symptoms and correlating this with the findings from a physical examination. The physical examination (performed by a health professional) involves listening to the lungs with a stethoscope where audible signs may be present – known as crackles, and through the use of an X-ray to identify if and where the mucus is being trapped within the lungs.

Auscultation2

Figure 5: Listening to the lungs for course crackles which indicate mucus build up

Sarah listening

 

 

 

 

 

 

 

 

Treatment 

Generally, pneumonia is treated either in the hospital if the case is bad enough or at home with fluids, antibiotics and rest. HOWEVER, chest physiotherapy may be the key to speeding up recovery time, clearing that yucky mucus and preventing harmful health effects by decreasing the length of time for taking medications and antibiotics.

BUT HOW?

Chest physiotherapy includes hands on movements over the patient’s chest wall, known as percussions, vibrations and shakes.

baby image chest2

Figure 7: Toddler Chest Physio is an important treatment for reduced risk of chest infections

Figure 6: Percussion technique with cupped hands

Figure 6: Percussion technique with cupped hands

 

 

 

 

 

 

 

 

Percussions 

Percussions involve the therapist rhythmically striking the patients chest wall with cupped hands. This helps to loosen the mucus in the air sacs and facilitate mobilization to the central airways where they can be coughed and cleared.

Vibrations and shakes  

This this technique involves the therapist’s hands being placed over the patient’s chest wall during expiration and a vibratory force being applied in the normal direction of movement of the chest. This augments expiratory flow and may assist in mobilizing secretions as the movement loosens secretions to then be moved by the air being expired. This technique may either be a course movement – shakes, or a finer movement – vibrations.

Postural Drainage:

vids

Figure 8: Sarah (USYD Physio Student) percussing Matt (bounceREHAB Physio) at bounceREHAB, Pyrmont health clinic.

The above techniques may be done over both sides of the chest wall, changing sides every 5 minutes for a total of 30-45 minutes. If there is a specific part of the lung that is most affected (identified in the x-ray or through listening to the lungs) percussions and other manual techniques may be combined with positioning, known as postural drainage, which involves placing the affected lobe most uppermost using the force of gravity to assist in effectively draining the secretions from the smaller, outside airways, to the central airways to be coughed up and cleared.

So what does the evidence say?  

Despite the lack of recent research into this area of physiotherapy, insight into the mechanism behind the treatment is enough to conclude its effectiveness. The lack of research basically stems from chest physiotherapy being considered “standard treatment” within the hospital system for many years now. Hence it would simply be unethical to not provide this treatment for the purpose of research – especially when the effects are so clearly seen.

Over the many generations that chest physiotherapy has been used to treat patients with varying lung infections, a general consensus of effectiveness has evolved among both health professionals and patients. This demonstrates that we don’t necessarily have to study and test a treatment technique when we understand how it works – in this case, how chest physiotherapy clears secretions.

How can the team at bounceREHAB help your resolving case of pneumonia?

Why bounceREHAB? bioceuticals-clinical

At bounce, not only can we provide chest physiotherapy as described above, but we can provide a dynamic team approach to help you fight the infection and get back to a fitter, healthier version of yourself.

Talk to Caroline Zinelli, our amazing nutritionist, about implementing the ideal diet. Caroline is also has an expert knowledge of our Clinical BioCeuticals supplements range and have a read of the few suggested supplements, and there ingredients, here to help boost your immune system to fight the infection:

  1. Armaforce – armaforce bioceuticals
  • Andrographis: plant native to South Asian countries and frequently used to prevent and treat the common cold and flu and also used for treatment of infections such as: leprosy, tuberculosis and pneumonia. It is used as a bacteria killing agent, pain killer, and fever reducer.
  • Echinacea: herb that is widely used to treat infections, especially common cold, flu and upper respiratory tract infections. Echinacea activates chemicals in the body to decrease inflammation and has been shown in some research to stimulate the body’s immune system
  • Zinc is an essential mineral and plays an important role in immune function. It can be found in red meat and poultry.
  • olive leaf has been used medicinally for many years. It is an antioxidant, anti-aging, anti-inflammatory and immune-stimulator.
  1. Quercetain: bioceuticals-quercetainreg_large
    contains flavonoids which are a class of plant. They contain antioxidant and anti-inflammatory health benefits and can be found in: parsley, blueberries, black tea, wine, cocoa and citrus fruits. This product may reduce the release of histamine to reduce inflammation.
  2. Vitamin C:bioceuticals-ultrapotent-creg_large
    is a water soluble vitamin and powerful antioxidant, helping to repair and regenerate tissues. It may lessen the duration and symptoms of the common cold to support a healthy immune function. Food high in vitamin C
    include: fruits such a berries, apples, lemons, limes, oranges and melons as well as vegetables including: asparagus, cabbage, kale, spinach and capsicum. During a time of acute infection, the body needs extra vitamin C to fight the infection, where you can either up your intake of these fruits and vegetables or take supplements.
  3. Probiotics:bioceuticals-ultrabiotic45_large
    when taking antiobiotics, your
    body loses the good bacteria. Taking probiotics can replace these. Lactobacillius is the probiotic found in yoghurt and other fermented foods
    and bifidobacterium is found in other dairy products.
  4. Lactoferin plus SB:
    helps reduce the risk of nausea, bloating and other side effects that may be bioceuticals-lactoferrinplussb-blac30_190x250associated with use of antibiotics and also provides immune system support.

Other dietary recommendations:

  1. Pineapple: upping your intake of pineapple during an acute infection. Pineapples are high in the enzyme bromelain which is an anti-inflammatory, it also contains the antioxidant vitamin C which boosts the immune system and decreases the severity of colds and flu.
  2. Dairy:
    Dairy products are pro-inflammation foods and therefore are something to avoid when your body is already in an inflamed state. The consumption of these foods during a time of acute infection may result in secretions becoming harder to clear, this is due to the presence of glycoproteins in dairy products that doesn’t allow the mucus to break down.

 dairy cow

EXAMPLE OF A PHYSIOTHERAPY SESSION:

  1. Auscultation: the therapist will have a quick listen to the patients breathing using the stethoscope to identify and predominant areas with course crackles which signifies sputum build up. This will also as act as a tool to monitor improvement from session to session
  2. Positioning: the patient is positioned depending on the most affected area, otherwise if both sides of the lungs are affected the patient is positioned in side-lying and sides are alternated every few minutes.
  3. Hands on manual techniques: the therapist may perform a total of 30 minutes’ therapy. This may look like: –> 3 minutes of percussions each side of the lungs –> every 3 minutes the patient is given a break and may perform a cough to expel sputum (phlegm) from the chest –>repeat

    Thumbs Up Sarah

    Thumbs up to everyone that got to the end of my blog on Pneumonia and Chest Physiotherapy in Private Practice (bounceREHAB)

 

 

 

 

 

 

 

 

 

 

 

LINKS:

BioCeuticals page : https://www.bioceuticals.com.au

Caroline Zanelli – bounceREHAB nutrition – http://www.bouncerehab.com.au/team/

Pryor and Prasad – Physiotherapy for respiratory and cardiac problems 4th edition (2008)