Physiotherapy plays a vital role in the management of pneumonia, particularly in hospital settings and for patients with severe symptoms or underlying respiratory conditions.

• Respiratory Assessment: Auscultation (listening to breath sounds for crackles, diminished sounds), percussion, palpation, and observation of breathing patterns (rate, depth, accessory muscle use).
  • Oxygen Saturation (SpO2): Monitoring oxygen levels.
  • Cough Assessment: Efficacy of cough, sputum production (amount, color, consistency).
  • Pain Assessment: Chest pain, musculoskeletal pain.
  • Functional Capacity: Assessment of mobility, strength, and endurance.
  • Medical History: Reviewing underlying conditions, medications, and imaging (X-rays, CT scans).
• Airway Clearance Techniques (ACTs): These are central to physiotherapy for pneumonia.
  • Manual Techniques
  • Percussion/Clapping: Rhythmic striking of the chest wall over the affected lung segment to dislodge mucus.
  • Vibrations/Shaking: Gentle, sustained pressure applied to the chest wall during exhalation to move secretions towards larger airways.
  • Postural Drainage: Positioning the patient to allow gravity to drain secretions from specific lung segments into the main airways, where they can be coughed up. This requires knowledge of lung anatomy and segment positioning.
  • Active Cycle of Breathing Techniques (ACBT): A patient-led technique involving:
  • Breathing Control: Gentle breathing to relax airways.
  • Thoracic Expansion Exercises: Deep breaths to get air behind secretions.
  • Forced Expiration Technique (FET)/”Huffing”: Short, sharp expirations (like steaming up a mirror) to move secretions from peripheral to central airways, followed by a cough.
  • Autogenic Drainage: A self-drainage technique using varying depths and speeds of breathing to mobilize secretions from peripheral to central airways without forced coughing.
• Positive Expiratory Pressure (PEP) Devices:
  • PEP Mask/Valve: Breathing out through a device that provides resistance, creating positive pressure in the airways, which helps to stent airways open and move secretions.
  • Oscillatory PEP (e.g., Acapella, Flutter valve): Combines PEP with oscillations to vibrate secretions and make them easier to clear.
  • Assisted Cough Techniques: For patients with weak coughs, manual assistance (e.g., abdominal thrust) to make the cough more effective.
• Breathing Exercises and Re-education
  • Diaphragmatic Breathing (Abdominal Breathing): Teaching patients to use their diaphragm more effectively to reduce the work of breathing and improve ventilation, especially in the lower lung lobes.
  • Pursed-Lip Breathing: Breathing out slowly through pursed lips helps to keep airways open, reduce air trapping, and control shortness of breath.
  • Segmental Breathing: Directing breath to specific areas of the lungs to improve ventilation in under-inflated segments.
  • Breathing Control Strategies: Teaching patients how to manage breathlessness during activity.
• Mobility and Exercise Progression-
  • Early Mobilization: As soon as medically stable, encouraging sitting up, standing, and walking, even short distances. This helps to improve lung expansion, prevent deconditioning, and reduce the risk of secondary complications like deep vein thrombosis (DVT).
  • Graded Exercise Program: Progressing from bed exercises to ambulation, then increasing intensity and duration of activity as tolerance improves. This combats deconditioning and improves overall functional capacity.
  • Incentive Spirometry: Using a device to encourage deep breaths and lung expansion, preventing atelectasis (lung collapse).
• Postural Management
  • Optimizing body positioning to promote lung expansion and comfort. This includes frequent position changes to prevent pressure sores and improve ventilation distribution.
  • Head of bed elevation to reduce aspiration risk.