1.1 The scope of respiratory physiotherapy

Patients with respiratory problems are encountered in many different settings, from long-term care in the community to critically ill patients on an intensive therapy unit (ITU) (also known as critical care) (Figs 1.1–1.3). Respiratory care may be an integral part of the patient’s management in secondary care (hospital) settings, such as respiratory, medical, and surgical and orthopaedic wards as well as burns, care of the elderly, paediatric, neurological, neurosurgical and oncology units. It may also be required for patients with mental health problems or learning disabilities. Physiotherapists work in many of these settings and also within primary care (in the community) for the longer-term rehabilitation of these patients. They may be employed in multiprofessional ‘rapid response’ or ‘early discharge’ teams, in which they share the responsibility for assessing and managing acutely ill patients in their own home.

Fig 1.1 Patient with chronic obstructive pulmonary disease at home with oxygen.

Fig 1.2 Pulmonary rehabilitation.

Fig 1.3 The intensive therapy unit (critical care) setting.

This book will cover physiotherapy assessment in any of the above settings. It is recognized that our role with many respiratory patients may be directed more towards function and rehabilitation than towards specific respiratory problems. Although the focus of this book will be on the assessment of the cardiovascular and respiratory systems, the checklists and tools also include reference to some generic assessment procedures (e.g. functional assessment) and aspects of musculoskeletal and neurological assessment (e.g. pain assessment and muscle testing); however, these have not been considered in detail and the reader is directed to other books in the toolkit series for further information.

The case history in Box 1.1 illustrates the scope of respiratory physiotherapy.