Respiratory References

Question 1

What are the psychometric properties for auscultation (with reference(s) & critical analysis)?

Answer 1

• Sensitivity: 37% (low)
• Specificity: 89% (acceptable)
• Positive LR: 3.2
• Negative LR: 0.72
• Validity: Not mentioned in the study
• Reliability: Good Intra-Rater reliability, Moderate Inter-rater reliability, no change in reliability depending on clinical experience
• Feasibility: Very good

Arts et al (2020) - Meta-Analysis (Nature, IF = 69.5)

Recommends that when a different clinical modality is available, this should be implemented instead- Lung ultrasound? Cox et al (2020).

Question 2

Bellie et al. 2021(narrative review) “airway clearance techniques: right choice for right patient”

Answer 2

• Little superiority of one treatment over another for ACT techniques: PD, Positioning( V/Q), ACBT, Manual techniques
• best treatment is the one that is adhered too. This means in a patient centred approach taking into account patient preferences, perceived effectiveness, and satisfaction. One that will best fit the context of there lives.

Question 3

Zizi at al. 2022 “the effectiveness of ACBT with people with chronic disease”

Answer 3

• demonstrates efficacy to improve pulmonary function- increased FEV-1 and FVC
• increases sputum volume to expectorate and helps relive symptoms of dysponea

Question 4

NICE Guidelines 2019- rehabilitation after critical illness

Answer 4

• more people are surviving critical illness. There is a misconception that people return to baseline, however most people have residual problems (less focus on survival, more in rehab potential) .

STG/LTG extremely important to keep patients engaged in rehab process and tackling deficits on d/c. All pts should have 2/3 month review in community regarding;

Important factors for rehab (bio-psycho-social)

• bio (physical impairments)- muscle loss, weakness, fatigue respiratory issues,
• psycho- fear, anxiety, depression, PTSD (referral support needed)
• social- how to engage back with work, driving, home life

Question 5

Larsen 2019- early mobilisation with people with pnemounia (systematic review)

Answer 5

• help mitigate the effects of deconditioning- loss of muscle, muscle weakness, fatigue, respiratory complications
• help increase individuals functional rehab capacity and QOL relating to physical function
• DIDNT DO- decrease mortality relates, hospital readmissions

Question 6

Hodgson (2014) “expert consensus and recommendations on safety criteria for active mobilisation of patients for mechanically ventilated patients”

Answer 6

• FIO2 below 60%
• RR below 30
• oxygen sats 90%+
• no contraindications (low RBC count- anaemia, low haemoglobin (less than 8g/dL)

Question 7

What are the 4 key treatments for Pneumonia (with references)

Answer 7

1. Positioning for VQ matching and postural drainage (McKoy et al, 2016)
2. ACBTs (Zisi et al, 2022 & Belli et al, 2021)
3. Patient Education (NICE Guidelines…, 2014)
4. Early, progressive mobilisation (BTS & ACPRC Guidlines…, 2009)

Question 8

What were the findings of the systematic review by Bausewein et al (2007) regarding measures of breathlessness/dyspnoea?

Answer 8

• There was at the point of the review no scale that can accurately measure the far-reaching impacts of dyspnoea in patients with advanced/chronic diseases.
• The mBorg was the most responsive measure for detecting changes in breathlessness severity, while the MRC scale showed a poor ability to detect changes.
• The review recommends a mixed methods approach to the assessment of dyspnoea - with the use of a unidimensional measure, disease-specific QoL measure, and qualitative investigation of further reaching psychosocial impacts.

Question 9

What patient information provision is reccomended by the 2014 nice guidelines for the Management of Pneumonia?

Answer 9

Information Surrounding Prognosis:
* 1 week: fever should have resolved
* 4 weeks: chest pain and sputum production should have substantially reduced.
* 6 weeks: cough and breathlessness should have substantially reduced.
* 3 months: most symptoms should have resolved but fatigue may still be present
* 6 months: most people will feel back to normal

Question 10

What were the key findings of Zisi et al (2022) regarding ACBTs (With critical analysis)?

Answer 10

• ACBT is effective an effective treatment for the short term improvement in respiratory tract secretion clearance and pulmonary function when compared to other treatment modalities.
• Effective in increasing the expectorated sputum volume, in reducing viscoelasticity of the secretion and in relieving symptoms such as dyspnea. (20-40% reduction in dyspnoea).
• However, Most studies revealed that ACBT/FET had at least an equally beneficial short-term effect on sputum wet weight, FEV1 and FVC compared to other treatment methods.

Critical Analysis:
* Journal: Heart & Lung J (IF = 3.1)
* Design: SR (Incl. 11 moderate-good quality RCTs)

Question 11

What were the key findings of Belli et al (2021) regarding ACBTs (With critical analysis)?

Answer 11

• ACBTs are comparable to other techniques in terms of patient preference, lung function, sputum weight, oxygen saturation and number of lung exacerbations, lung function, exercise capacity and quality of life.
• For a long-term use - patient adherence to treatment is greater if self-administered techniques are used
• Always consider the patient’s preferences, and base one’s choices about which technique to use not only on the relief of symptoms, but also on the adaptability of the technique to the patient’s lifestyle.

Critical Analysis
* Journal: Frontiers of Medicine (IF = 9.9)
* Design: SR

Question 12

What were the key findings of McKoy et al (2016) regarding ACBTs (with critical analysis)?

Answer 12

• ACBTs are as equally effective as autogenic drainage and manual techniques in short-term symptom relief for patients with cystic fibrosis. No significant difference was seen in quality of life, sputum weight, exercise tolerance, lung function, or oxygen saturation.
• Patient preferences were true to the following order: Autogenic drainage, ACBTs, and Manual Techniques.

Critical Analysis
* Journal: Cochrane Library (IF =11.9)
* Design: SR

Question 13

What are the recommendations of the BTS & ACPRC Guidelines for the physiotherapy management of the adult, medical, spontaneously breathing patient (2009)?

Answer 13

• Medical condition permitting, patient should be out of bed for at least 20 minutes a day within the first 24h of admittance to hospital with mobility being increased daily.
• Patients admitted with primary uncomplicated pneumonia should not be treated with traditional airway clearance techniques routinely. (Grade B)
• In patients with uncomplicated community-acquired pneumonia admitted to hospital, the regular use of positive expiratory pressure should be considered. (Grade B)

Question 14

What are the four key treatments for COPD (with references)?

Answer 14

1. Smoking Cessation (GOLD Standards 2023 & NICE Guidlines … 2018)
2. Pulmonary Rehabilitation (GOLD Standards 2023 & NICE Guidelines … 2018)
3. Inhaler Training (GOLD Standards 2023 & NICE Guidelines … 2018)
4. ACBTs (NICE Guidelines … 2018)

Question 15

According to the 2018 NICE Guidelines for the diagnosis and management of COPD, what treatments are the explicit responsibility of physiotherapists?

Answer 15

1. Teaching the use of PEP devices
2. Provision of ACBT education

Question 16

What are the key recommendations/findings of the Global Initiative for Chronic Obstructive Lung Diseases (GOLD) Standards 2023?

Answer 16

• Pulmonary Rehabilitation*: “a comprehensive intervention based on thorough patient assessment followed by patient-tailored therapies that include, but are not limited to, exercise training, education, self-management intervention aiming at behavior change, designed to improve the physical and psychological condition of people with chronic respiratory disease and to promote the long-term adherence to health-enhancing behaviors.” (Grade A Evidence)
• Education alone has been shown to be ineffective (Grade C evidence)
• Self Management with communication with a healthcare professional improves health status and decreases hospitalisations (Grade B Evidence)
• Smoking Cessation interventions should be actively pursued in all people with COPD (Grade A Evidence)
  Physical activity is a strong predictor of mortality in patients with COPD (Grade A Evidence). People with COPD should be encouraged to increase PA levels.
• Assessment of Inhaler adherence and technique - provide training if necessary.

Question 17

What are the key recommendations/findings of the 2018 NICE Guidelines for the diagnosis and management of COPD?

Answer 17

• Smoking Cessation: At every opportunity, advise and encourage every person with COPD who is still smoking (regardless of their age) to stop, and offer them help to do so.
• Inhaler Training (if indicated): People with COPD should have their ability to use an inhaler regularly assessed and corrected if necessary by a healthcare professional competent to do so
• Pulmonary Rehabilitation: Make pulmonary rehabilitation available to all appropriate people with COPD, including people who have had a recent hospitalisation for an acute exacerbation.
  Offer pneumococcal vaccination and an annual flu vaccination to all people with COPD, as recommended by the Chief Medical Officer.
  If people have excessive sputum, they should be taught: how to use positive expiratory pressure devices, and active cycle of breathing techniques.
• Patient Education: At a minimum, the information should cover: an explanation of COPD and its symptoms, advice on quitting smoking (if relevant) and how this will help with the person’s COPD, advice on avoiding passive smoke exposure, managing breathlessness, physical activity and pulmonary rehabilitation, medicines, including inhaler technique and the importance of adherence, vaccinations, identifying and managing exacerbations, details of local and national organisations and online resources that can provide more information and support, how COPD will affect other long-term conditions that are common in people with COPD (for example hypertension, heart disease, anxiety, depression and musculoskeletal problems).