Respiratory physiotherapy in the community: Bronchiectasis and other chronic conditions

Respiratory Physio 1 - Respiratory physiotherapy in the community: Bronchiectasis and other chronic conditions

Article by Graceville Physiotherapist Matthew Fowler

Bronchiectasis and other similar respiratory conditions have been on the rise globally.  Despite a lack of clear data in Australia, UK studies have demonstrated prevalence between 43.4/100,000 for younger adults (18-30 years) up to 1239.7/100,000 for those in their 8 th decade of life [1]. The Australian Institute of Health and Welfare identified that bronchiectasis on its own accounted for 0.2% of all hospitalisations over a 2017-18 period, and that these hospitalisations were on average over 3 days longer than the average inpatient stay (6.3 days vs 2.7 days)[2]. This is part and parcel with the fact that bronchiectasis is associated with recurrent infections, requiring varied antibiotic treatments. Not only are these recurrent infections a source of costly hospital admissions, but also repeated use of antibiotics are an additional strain towards the looming concern of antibiotic resistance.

As is becoming the norm with many chronic conditions, self-management and prevention of flare ups is becoming increasingly important, and is a recommended direction of treatment by the World Health Organisation (WHO). Provision of appropriate education and management techniques geared towards empowering patients is key, especially when considering that bronchiectasis is far more common in patients from a background of traditionally lower health literacy and affluence [3,4]. It is important to provide education to patients regarding explanations for their disease, understanding exacerbating factors, and the importance of their self management approaches. It has been identified by patients themselves that instruction and demonstration on how to perform many self management techniques are a priority for education, and is preferable to mere explanations of lung anatomy and function [5,6].

Physiotherapists are trained in major components of respiratory function and mechanics. Not only are they capable of equipment provision and education, but they can also approach respiratory function from a musculoskeletal perspective, informing not only self management techniques for breathing exercises, but also appropriate function of the diaphragm, accessory breathing muscles, and thoracic mobility.

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References:

1.Quint JK, et al. Changes in the incidence, prevalence and mortality of bronchiectasis in the UK from 2004-2013: a population based cohort study. Eur Respir J. 2016;47(1):186-93

2. Australian Institute of Health and Welfare 2020. Bronchiectasis. Cat. No. ACM 36. Canberra: AIHW. HTTPS://www.aihw.gov.au/reports/chronic-respiratory-conditions/bronchiectasis

3.Chang AB, Mabel JP, Boyce NV, Wheaton G, & Torzillo PJ. Non-CF bronchiectasis: clinical and HRCT evaluation. Paediatric Pulomonology. 2003;45(6):477-83

4.Kara day B, Karakoc F, Ersu R, Kurt A, Bakac S, & Dagli E. Non-Cystic-Fibrosis Bronchiectasis in children: A persisting problem in developing countries. Respiration. 2014;72(3):223-8

5.Hester KLM, et al. Living your life with bronchiectasis: an exploration of patients and careers information needs informing development of a novel information resource. Thorax. 2015;70:201

6.Takakura S, Hasegawa T, Ishihara K. Assessment of patient’s understanding of their asthmatic condition established in an outpatient clinic. Eur Respir J. 1998;12