Cardiopulmonary Physiotherapy
This domain tests airway clearance technique selection and safe, effective exercise prescription in people with cardiac or respiratory disease. Items frequently ask which technique suits which secretion problem, or how to set and monitor exercise intensity.
Assessment essentials
Record vital signs, oxygen saturation, Borg dyspnoea and RPE, sputum volume and colour, and auscultation findings: crackles suggest secretions or oedema, wheeze suggests bronchoconstriction, pleural rub suggests pleurisy. Note the mMRC dyspnoea grade and any recent exacerbation.
Airway clearance
- Active cycle of breathing technique: breathing control, thoracic expansion exercises, then a forced expiration technique (huff). A medium-volume huff mobilises peripheral secretions; a high-volume huff clears central airways.
- Autogenic drainage uses controlled breathing at three lung volumes without huffing.
- Positive expiratory pressure and oscillating PEP splint airways open in collapse-prone patients.
- Postural drainage uses gravity-assisted positions; contraindications include raised intracranial pressure, recent haemoptysis, unstable spinal injury, and discomfort that prevents the position being tolerated.
Exercise prescription
- Pulmonary rehabilitation: typically 6–12 weeks, twice or three times weekly, combining high-intensity aerobic and resistance training; it improves dyspnoea and quality of life and reduces readmission.
- Cardiac rehabilitation: phase I inpatient mobilisation, phase II supervised outpatient, phases III–IV maintenance.
- Six-minute walk test: 30-metre corridor; a change of about 30 m is the accepted minimum important difference in COPD; do not test with unstable angina, resting tachycardia above about 120 bpm, or saturation below 85%.
- Oxygen targets: 88–92% for COPD patients at risk of hypercapnia; 94–98% otherwise.
Worked example
A patient with COPD walks 320 m in six minutes and stops for dyspnoea at Borg 5. Reasoning: prescribe interval or continuous walking at roughly 60–80% of that walking speed, or around 80% of peak work rate from a cycle test, targeting Borg 4–6, with monitoring so saturation stays at or above 88%. If desaturation occurs, titrate supplemental oxygen and reassess technique of breathing control and pacing.
Traps that cost marks
- Using a small huff when secretions are peripheral, or a forced cough in a patient with bronchospasm.
- Applying a healthy-person oxygen target to a CO2-retaining COPD patient.
- Quoting percentage of maximum heart rate without saying whether it is measured or estimated.