• Increased difficulty breathing: Everyday tasks become challenging.
• Increased mucus production: Often with changes in color (yellow or green) indicating infection.
• Frequent lung infections: Such as colds, flu, and pneumonia, which can further damage the lungs.
• “Barrel chest”: The chest may appear enlarged due to the trapped air in the lungs.
• Use of accessory breathing muscles: Visible effort in the neck and shoulder muscles to breathe.
• Pursed-lip breathing: A technique some people instinctively use to help exhale trapped air.
• Cyanosis: Bluish tint to the lips or fingernail beds due to low oxygen levels (a sign of severe disease).
• Peripheral edema: Swelling in the ankles, feet, or legs.
• Heart problems: Emphysema can lead to increased strain on the heart, potentially causing heart enlargement or failure.
• Anxiety and depression: Due to the chronic nature of the disease and its impact on quality of life.

Advanced Physiotherapy for Emphysema

While there is no cure for emphysema, advanced physiotherapy, often as part of a pulmonary rehabilitation program, plays a crucial role in managing symptoms, improving lung function, enhancing exercise tolerance, and improving overall quality of life. Physiotherapy interventions are highly individualized and depend on the severity and specific needs of the patient.

Advanced physiotherapy for emphysema include

• Breathing Techniques and Retraining:
  • Pursed-lip breathing: Taught to help slow down breathing, keep airways open longer, and release trapped air.
  • Diaphragmatic (belly) breathing: Focuses on using the diaphragm more effectively, which is the primary muscle of respiration, to improve breathing efficiency and reduce effort.
  • Controlling respiratory rate and volume: Learning to breathe calmly and efficiently to conserve energy.
  • Relaxation breathing exercises: To help manage breathlessness and reduce anxiety.
• Secretion Clearance Techniques:
  • Active Cycle of Breathing Techniques (ACBT): A series of breathing exercises to mobilize and clear mucus from the airways.
  • Autogenic drainage: A self-drainage technique that helps clear mucus by controlling the depth and speed of breathing.
  • Positive Expiratory Pressure (PEP) therapy: Using devices to create positive pressure during exhalation, helping to open airways and move mucus.
  • Oscillating PEP devices: Combine PEP with vibrations to further loosen mucus.
  • Effective/productive coughing techniques: Teaching patients how to cough effectively to clear secretions without excessive strain.
  • Postural drainage: Positioning the body in specific ways (sitting, lying) to allow gravity to help drain mucus from different lung segments.
  • Manual assistance: Techniques like percussion (clapping on the chest) and vibrations performed by a therapist to help dislodge mucus.
• Exercise Assessment and Prescription:
  • Aerobic exercise: Graded exercise programs (e.g., walking, cycling) to improve cardiovascular fitness, endurance, and the body’s ability to use oxygen.
  • Resistance training: Strengthening exercises for both upper and lower extremities to improve muscle strength, reduce muscle wasting, and make daily activities easier.
  • Flexibility exercises: To maintain range of motion and reduce stiffness.
  • Balance training: To reduce the risk of falls, especially in individuals with impaired balance due to breathlessness or fatigue.
  • Energy conservation techniques: Teaching patients strategies to perform daily tasks with less effort, such as sitting for tasks, pacing activities, and using assistive devices.