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Physiotherapy for COPD

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Physiotherapy plays a vital role in treating COPD, with high-level evidence that the interventions can aid in faster recovery and prevent recurrence.

Medically reviewed by

Dr. Kaushal Bhavsar

Published At February 16, 2024
Reviewed AtMarch 20, 2024


Chronic obstructive pulmonary disease (COPD) is a prevalent condition that affects the bronchopulmonary system. The progression of COPD is associated with the emergence of extrapulmonary consequences, including cardiovascular illnesses, osteoporosis, cachexia, skeletal muscle dysfunction, anxiety, and depression. As a result, people with COPD experience degradation of health-related quality of life and increased physical intolerance.

Pulmonary rehabilitation is a comprehensive approach to treating people with chronic lung illnesses. It is individualized, and its main objective is to improve the patient's physical and social condition. The key component of pulmonary rehabilitation is physical therapy (PT). By utilizing several therapeutic workouts and breathing techniques, physical therapy (PT) improves quality of life by reducing dyspnea, enhancing physical tolerance, and enhancing mobility in everyday activities.

What Is COPD?

Chronic obstructive pulmonary disease comprises emphysema, chronic bronchitis, and chronic asthma. COPD is typically brought on by repeated exposure to irritants that harm the lungs and airways, including tobacco smoke. The emergence of COPD may also be influenced by inhaling secondhand smoke, air pollution, chemical fumes, or dust from the environment or place of employment.

According to data from the British Lung Foundation, heart illness, musculoskeletal disorders, and mental health conditions are the UK's three most expensive disease areas. Lung disease ranks fourth. Millions of people are thought to have the illness than the estimated 1.2 million who had it identified, and new projects are actively working to find these "missing millions."

How Does Physiotherapy Aid COPD?

A physiotherapist can demonstrate breathing strategies if a person frequently hyperventilates (breathes too rapidly) or struggles to expel phlegm from the chest. Physiotherapists can assist patients in controlling COPD-related dyspnea. They can instruct the posture and breathing techniques, offer guidance on managing the activity, and demonstrate coping mechanisms.

Physiotherapists are crucial in assisting patients with COPD hospitalized with respiratory issues to clean their chest, control their lung condition, and resume their normal activities. Additionally, physiotherapists may help persons with COPD manage upcoming outbreaks of their condition and assist them in returning home from the hospital after becoming ill. The techniques are:

Non-Invasive Ventilation:

Physiotherapists are regularly involved in providing non-invasive ventilation, evaluating and referring suitable patients, enrolling patients in treatment, titration of pressures, maximizing patient tolerance, and monitoring treatment outcomes. Non-invasive ventilation might help with administering other physiotherapies, like early mobilization. The use of non-invasive ventilation and oxygen during walking in a group of hospitalized patients who were recovering from acute-on-chronic respiratory failure and the majority of whom had COPD led to significant improvements in walking distance, oxyhemoglobin saturation, and exercise-induced dyspnea compared to walking on oxygen alone.

Breathing Exercises:

Breathing exercises are widely used by physiotherapists to treat COPD patients who are experiencing acute exacerbations of dyspnea, increased functional ability, and increased thoraco-abdominal coordination. Breathing control usually referred to as diaphragmatic or abdominal respiration, and pursed lip breathing (soft exhalation through tightly pursed lips) are two commonly utilized strategies. Despite their frequent usage in clinical practice, there is little proof that breathing exercises in AECOPD (acute exacerbation of chronic obstructive pulmonary disease) provide significant advantages.

Patients who participated in twice-daily controlled breathing sessions under the supervision of a physiotherapist, which included relaxation techniques, pursed lip breathing, and active expiration, saw larger reductions in anxiety, depression, and dyspnea than those who received standard therapy. Similarly, diaphragmatic respiration and pursed lip breathing exercises were performed while a patient was being treated for AECOPD, and the level of exhaustion was reduced compared to standard treatment.

It is unclear if other physiotherapy procedures, like airway clearance techniques, exercise training, or mobilization, considered standard procedures in several settings, were included in either study's definition of "usual care." No research has been done on outcomes after hospital admission. These limited studies do, however, offer some preliminary proof that using breathing exercises can help with AECOPD symptom control.

The management of symptoms during an AECOPD may benefit from some breathing strategies, such as pursed lip breathing, but it does not apply to deep breathing exercises that try to increase lung volume. In an AECOPD, when airflow blockage, hyperinflation, and expiratory flow limitation are the main deficits, increasing lung capacity may have negative effects. Studies on people with COPD have revealed that while deep breathing exercises may improve blood gases and ventilation, they are also associated with greater dyspnea, higher inspiratory muscle work, and decreased mechanical efficiency of breathing. Therefore, deep breathing techniques are not used in the physiotherapy care of AECOPD.

Early Mobilization and Rehabilitation:

Early mobilization is a crucial component of physiotherapy treatment for AECOPD to prevent functional deterioration and facilitate hospital release. To ensure a safe discharge back into the community, this includes early ambulation that begins within 24 hours of hospital admission. It may also include focused physical activity and goal-directed exercise (such as stair training).

Early mobilization can be used before, during, or after an AECOPD. Early rehabilitation is a more intense method. Patients just beginning to recover from an AECOPD are given early therapy using the well-known pulmonary rehabilitation concepts. This covers the use of strength training and/or moderate-to-vigorous endurance exercise. Early research indicated that this training strategy is secure even during the first few days of hospitalization, with no serious side events and no rise in indicators of systemic inflammation.


The detrimental effects of the AECOPD on skeletal muscle function and physical activity may be reversed with pulmonary rehabilitation, which must involve full-body exercise training. By giving opportunities to improve nutritional status, address psychosocial problems like anxiety and depression, which are linked to exacerbation risk, encourage early detection and treatment of exacerbations, and improve self-management skills, pulmonary rehabilitation's non-exercise elements may also help prevent future exacerbations.

To ensure program acceptance and completion, physiotherapists must pinpoint and address any specific impediments to attendance. Finally, physiotherapists should be more involved in avoiding the occurrence of future AECOPD. Physiotherapists have the tools to have a long-term impact on the health, happiness, and longevity of persons with COPD by using evidence-based treatments like rehabilitation and self-management training.

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Dr. Kaushal Bhavsar
Dr. Kaushal Bhavsar

Pulmonology (Asthma Doctors)


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