Chronic lung disease is a term for a group of long-term conditions that affect the lungs. At least one in 10 Australians has chronic lung disease. The most common conditions are chronic obstructive pulmonary disease (COPD, also known as emphysema, chronic bronchitis), asthma, bronchiectasis, cystic fibrosis, pulmonary hypertension, interstitial lung disease, mesothelioma and lung cancer. These diseases are characterised by symptoms such as breathlessness and cough. Physiotherapy plays an important role in the management of lung disease by offering pulmonary rehabilitation (exercise training, education and support), education on physical activity, airway clearance and breathing exercises.
--What causes lung disease?
There are a number of causes of lung disease including: smoking, air pollution, chemicals or occupational dusts, and genetic causes. While each type of lung disease has a different pathology, many of the symptoms (such as breathlessness) are similar. Chronic lung diseases cannot normally be cured, and therefore the focus is to maximise the person’s health and quality of life. There are many things that people with chronic lung disease can do to keep healthy and minimise their symptoms. Physiotherapists play an important role in working with people to maximise their quality of life.
--Why is lung health important?
The lungs are responsible for supplying oxygen to every organ in the body. This process is called respiration or breathing, which takes oxygen from the atmosphere, delivers it to the blood stream, as well as removing carbon dioxide from the body. Good lung health means you can breathe easily and effectively to allow your body to function well. Lung disease can make the process of respiration difficult or ineffective. Depending on the type of lung disease, common problems can be: trouble getting air into or out of the lungs, trouble getting oxygen into or around the body, problems with a build-up of phlegm or fluid in the lungs, or a growth of a tumour in or around the lungs. These problems can make it harder to move, exercise, work and do daily activities.
Smoking is the leading cause of lung disease. The risk of lung disease is significantly reduced for people who have never smoked or those who quit smoking. Quitting smoking is the most important step in improving your lung health.
Lung disease is a large problem in Australia. 14 per cent of all deaths in Australia caused by lung disease and it is responsible for 10 per cent of the overall burden of disease in Australians. It’s responsible for 3 per cent of hospitalisations and 5 per cent of hospital bed days. Management of lung disease is a top priority in Australia not only to keep people out of hospital, but also to help them better manage their disease and have a good quality of life.
--How do I know if I have a problem?
Common symptoms of lung disease are breathlessness (shortness of breath), wheezing, chronic coughing, coughing up phlegm or blood, chest pain, chest tightness, persistent fatigue and weight loss. Many of these symptoms are also experienced by a person who has a cold or the flu. However, the difference with chronic lung disease is that these symptoms do not resolve or go away. If you experience these symptoms for more than one to two weeks, you should consult your GP who may send you for diagnostic tests such as breathing tests (to measure how much air you can get in and out of your lungs), blood tests, lung scans (chest x-rays or CT scan) and fitness tests. You may also be referred to a specialist lung doctor (respiratory physician) for diagnosis and ongoing medical management.
--How can physiotherapy help treat lung conditions?
Physiotherapy is an important part of the management of lung disease and involves a variety of different treatments depending on your main symptoms. Overall, the most important aspect is exercise. Avoiding sedentary time and keeping up an active lifestyle is extremely important for people with lung disease to keep fit, healthy, strong and out of hospital.
--How much should I exercise?
It is recommended that people with lung disease do 30 minutes of aerobic exercise on at least five days of the week, such as brisk walking, jogging, riding on a stationary bike or swimming. It is also recommended to do strengthening exercises on two to three days of the week to keep your muscles strong. If you have had falls or poor balance, it is also recommended that you do balance exercises. If you’re not sure what kind of exercise is right for you, a physiotherapist can help.
--How hard should I exercise?
The most effective exercise is normally done at a ‘moderate’ intensity. This means that during exercise your heart rate is increased slightly and you get a bit puffed, but not so puffed that you cannot talk to the person next to you. On a scale of 0 (nothing) to 10 (very very strong) your breathing should be between 3 (moderate) to 4 (somewhat strong), while completing the aerobic exercise such as walking or cycling.
--Will exercise make my lung disease worse?
No, exercise will not make your disease worse. Exercise is safe for you. When we exercise, our lungs need to work harder to deliver more oxygen to our working muscles. Therefore, when we exercise it is normal to feel breathless. You may experience increased breathlessness when exercising, however that is a good sign that you are exercising and the breathlessness should go back to normal as soon as you stop the exercise. However, for safety it is recommended that you consult a physiotherapist or GP before you start exercising for the first time.
--What can group exercise classes do?
The easiest way to learn about these exercises is to see your physiotherapist and join a pulmonary rehabilitation program. These programs are widely available throughout Australia, located at hospitals or community centres, and are open to most people with lung disease. At the pulmonary rehabilitation program a physiotherapist will measure your exercise capacity, your symptoms and your safety for exercise. They will teach you how to do the exercises and then supervise you exercising in the group environment once or twice a week for six to eight weeks. As well, you will receive education on a number of topics such as medication, lung disease and managing breathlessness. Speak to your GP or physiotherapist for more information and to get a referral.
--What else can physiotherapy offer?
Depending on your specific lung disease and your main problems, physiotherapy may also involve a number of other treatments. A thorough assessment by a physiotherapist following diagnosis is a good place to start.
Physiotherapy may involve breathing exercises, airway clearance techniques and inhalation therapy to help clear phlegm from the airways. This is particularly important for people with bronchiectasis or cystic fibrosis as they commonly experience high volumes of phlegm on a daily basis and should perform airway clearance techniques across the lifespan. A physiotherapist can help you work out which is the best technique for you and how to integrate these techniques in your daily life to maintain clear and healthy lungs.
If you have trouble sleeping or breathing at night, a physiotherapist in conjunction with your respiratory doctor may prescribe a breathing machine such as continuous positive airway pressure (CPAP), non-invasive positive pressure (NIV), or bi-level positive airway pressure (BiPAP) to use to help your breathing.
Physiotherapy may also involve assessment and management of other conditions that can result from, or occur along-side, lung disease. These include musculoskeletal problems such as spinal or joint pain, restricted chest wall, ribs, arm movement, or poor posture; osteoporosis; and urinary incontinence (which is common due to chronic coughing).
--How effective is physiotherapy for lung conditions?
Physiotherapy is effective at improving many aspects of life for people with lung disease. There is a large body of research to confirm the effectiveness of physiotherapy for people with lung disease. The Lung Foundation Australia and the Thoracic Society of Australia and New Zealand have developed the COPD X guidelines to improve the management of people with COPD and recommend referral to pulmonary rehabilitation programs.
For people with COPD there is level I evidence (highest quality of evidence) that pulmonary rehabilitation reduces breathlessness, fatigue, anxiety and depression, improves fitness, emotional function and quality of life, and enhances patients’ sense of control of their disease. There is level II evidence that pulmonary rehabilitation reduces patients needing to go to hospital and that it is a cost-effective treatment. The research for pulmonary rehabilitation for patients with other types of lung disease has found similar results.
- Pulmonary rehabilitation for people with lung disease (international guidelines)
- Physiotherapy management for people with COPD
- Airway clearance techniques for people with COPD
- Pulmonary rehabilitation for interstitial lung disease
- Exercise for asthma
- Physiotherapy management for lung cancer
- Physiotherapy for cystic fibrosis
--What can I do at home?
The best thing to do at home is to walk every day and lead an active lifestyle. Try to undertake at least 30 minutes of exercise on most days of the week. Brisk walking is a safe and easy way to achieve this. Start slowly with short walks and build up to a 30 minute walk at a level of three out of ten (moderate) on the breathlessness scale. As well as daily walking, try to be as active as possible by avoiding too much sedentary time during the day such as sitting down for too long watching television. Some people wear activity trackers such as Fitbits, pedometers or smart phones to track the number of steps they take each day. This is a great way to monitor your activity levels and ensure you are keeping up an active lifestyle. You should aim to do 10 000 steps every day.
--How long until I’ll see results?
Most pulmonary rehabilitation programs run for six to eight weeks, however you may start to see improvements in your health even before this time. It is important to keep up the exercise once you complete the program as the research shows that the benefits gained do not last without ongoing exercise. Changing your lifestyle to be active long term is an important step you can take to maximise your health.
--How does physiotherapy fit within my overall management?
Physiotherapy is only one part of the overall management of lung disease. Other important aspects in the management of lung disease include stopping smoking, taking your respiratory medications as recommended, having a flu vaccination each year, ensuring that you have a good diet and a self-management plan. The self-management plan will help you recognise the signs of a new infection (exacerbation or flare-up) and how to respond quickly before it gets worse. It is best to speak to your general practitioner or physiotherapist about a self-management plan if you do not already have one.
--Where else can I find information?
The Australian Lung Foundation is another great resource for patients and they offer free patient support via a telephone service.
