Respiratory Physiotherapy

Support for breathing, airway clearance and physical activity

Respiratory conditions can affect breathing, energy levels and the amount of physical activity you are able to manage. Some people mainly experience breathlessness, while others may have difficulty clearing mucus, reduced exercise tolerance or weakness following illness or hospital admission.

Respiratory physiotherapy focuses on helping you manage these physical effects and improve how you breathe and move during everyday activities.

Treatment may include breathing techniques, airway clearance, exercise, positioning and strategies for managing breathlessness. The approach depends on your respiratory condition, symptoms and general health.

What is respiratory physiotherapy?

Respiratory physiotherapy is a specialist area of physiotherapy that supports people with conditions affecting the lungs and breathing.

Treatment may focus on:

• Managing breathlessness
• Clearing mucus from the chest
• Improving breathing control
• Increasing physical activity
• Rebuilding strength and endurance
• Improving mobility after illness
• Managing changes in breathing pattern
• Returning to everyday activities
• Developing techniques that can be continued independently

Not everyone attending respiratory physiotherapy will need the same type of treatment.

Someone who has difficulty clearing mucus may need a very different programme from someone whose main problem is breathlessness during activity.

When respiratory physiotherapy may help

An assessment may be useful if you are experiencing:

• Breathlessness during everyday activities
• Difficulty clearing mucus or phlegm
• A persistent feeling of chest congestion
• Reduced exercise tolerance
• Weakness following respiratory illness
• Difficulty walking longer distances
• Difficulty using stairs because of breathlessness
• Changes in breathing pattern
• Frequent coughing when trying to clear the chest
• Reduced confidence with physical activity
• Reduced mobility after hospital admission
• Difficulty returning to exercise
• Fatigue associated with a respiratory condition

Respiratory physiotherapy may also form part of rehabilitation for people living with a long-term lung condition.

Conditions respiratory physiotherapy may support

Respiratory physiotherapy may be used as part of the management of conditions such as:

• Chronic obstructive pulmonary disease (COPD)
• Bronchiectasis
• Asthma where physiotherapy input is appropriate
• Chronic respiratory conditions associated with mucus retention
• Breathing pattern disorders
• Recovery following chest infections
• Recovery after pneumonia
• Respiratory difficulties following prolonged hospitalisation
• Recovery after some types of surgery
• Long COVID where respiratory symptoms are present
• Other conditions affecting breathing and airway clearance

The role of physiotherapy depends on the condition and should work alongside appropriate medical treatment.

What happens during your first appointment?

Your first appointment begins with a discussion about your breathing, respiratory condition and how symptoms affect everyday life.

The physiotherapist may ask about:

• Your respiratory diagnosis
• Breathlessness
• Coughing
• Mucus or phlegm
• Chest infections
• Current medication
• Inhalers or other respiratory treatments
• Hospital admissions
• Walking ability
• Stairs
• Current exercise
• Fatigue
• Smoking history where relevant
• Other medical conditions
• Activities you currently find difficult
• What you would like to improve

The assessment may also look at:

• Your breathing pattern
• Chest movement
• Cough effectiveness
• Ability to clear secretions
• Walking
• Strength
• General mobility
• Physical endurance
• How breathing changes during activity

This helps determine which respiratory physiotherapy techniques are likely to be most appropriate.

What treatment may include

Treatment depends on your symptoms and the reason for physiotherapy.

Breathing control

Breathing control techniques may help you develop a calmer and more efficient breathing pattern.

This may involve working on:

• Slower breathing
• Relaxing the shoulders and upper chest
• Using comfortable breathing positions
• Reducing unnecessary breathing effort
• Coordinating breathing with movement

Breathing control can also be useful when recovering after periods of breathlessness.

Airway clearance techniques

If mucus is difficult to clear, physiotherapy may teach specific techniques to help move secretions through the airways.

Treatment may include:

• Breathing control
• Deep or thoracic expansion breathing
• Huffing
• Controlled coughing
• Positioning
• Other airway clearance techniques where appropriate

The most suitable technique depends on your condition and how much mucus you produce.

Exercise and physical conditioning

Respiratory conditions can make exercise feel difficult, but long periods of reduced activity may also lead to weakness and reduced fitness.

Where appropriate, rehabilitation may include:

• Walking
• Cycling
• Strengthening
• Sit-to-stand exercises
• Step exercises
• General conditioning

The programme can begin at a level you can manage and progress according to your symptoms.

Mobility and strengthening

If illness or hospital admission has reduced your strength, treatment may include exercises to rebuild everyday mobility.

This may focus on:

• Standing from a chair
• Walking
• Stairs
• Leg strength
• Upper-body strength
• General endurance

Home programme

You may receive breathing exercises, airway clearance techniques or physical exercises to practise between appointments.

The programme should be manageable enough to continue regularly at home.

Managing breathlessness

Breathlessness can make normal activities feel physically demanding.

You may notice it during:

• Walking
• Stairs
• Dressing
• Showering
• Household tasks
• Carrying shopping
• Exercise
• Talking while moving

Feeling breathless does not always mean that activity must stop completely.

Depending on the cause, rehabilitation may help you use breathing control, positioning and pacing to make activity easier to manage.

The underlying cause of breathlessness should also be medically assessed where appropriate.

Positions that may help with breathlessness

Certain positions can make breathing feel more comfortable during periods of breathlessness.

These may include sitting or standing with the arms supported and allowing the shoulders to relax.

The most useful position varies between individuals.

Physiotherapy can help you identify positions that allow you to recover more comfortably during or after activity.

Breathing during activity

People who become breathless may unintentionally hold their breath during movements such as standing, lifting or climbing stairs.

Learning to coordinate breathing with movement can sometimes make these activities easier.

For example, you may practise breathing out during the more demanding part of a movement.

This can be incorporated into:

• Standing from a chair
• Using stairs
• Lifting
• Reaching
• Strength exercises

The technique should feel natural rather than becoming another task you have to concentrate on constantly.

Clearing mucus from the chest

Some respiratory conditions cause mucus to collect in the airways.

If mucus is difficult to clear, it can contribute to:

• Coughing
• Chest congestion
• Breathlessness
• Reduced comfort
• Difficulty exercising

Respiratory physiotherapy can teach techniques designed to move mucus from smaller airways towards larger airways where it can be cleared more effectively.

The technique should be matched to the individual rather than relying on repeated forceful coughing.

Active cycle of breathing techniques

The active cycle of breathing technique, often called ACBT, is one method that may be used to help clear mucus.

It generally combines:

• Breathing control
• Deeper breathing exercises
• Huffing

These stages can be repeated depending on how much mucus needs to be cleared.

The technique may be modified according to your respiratory condition and response.

Huffing and coughing

Repeated strong coughing can sometimes be tiring and may not always be the most effective way to move mucus.

A huff is a controlled breath out through an open mouth.

Different huffing techniques can help move mucus from different parts of the airways before a cough is used to clear it.

A physiotherapist can demonstrate the technique and help you recognise when it is being performed effectively.

Managing a breathing pattern disorder

Some people develop a breathing pattern that remains faster, shallower or more upper-chest dominant than needed.

Symptoms may include:

• Breathlessness
• Frequent sighing
• Difficulty taking a satisfying breath
• Chest tightness
• Light-headedness
• Tingling
• Increased awareness of breathing

Respiratory physiotherapy may include breathing retraining to help establish a more comfortable and efficient pattern.

The approach is gradual and focuses on normalising breathing rather than repeatedly taking very large breaths.

Breathing pattern and posture

Posture does not cause every breathing problem, but body position can influence how comfortable breathing feels.

For some people, prolonged slumped or tense positions may contribute to increased use of the muscles around the neck and shoulders.

Treatment may include:

• Relaxed positioning
• Upper-body mobility
• Shoulder movement
• Thoracic mobility
• Breathing control

These strategies may be used alongside treatment for the underlying respiratory condition.

Exercise and respiratory conditions

Breathlessness can make people understandably cautious about exercise.

However, avoiding activity for long periods can lead to reduced cardiovascular fitness and muscle weakness.

This can create a cycle where smaller amounts of activity cause increasing breathlessness.

Where medically appropriate, rehabilitation may gradually increase physical activity.

Exercise may include:

• Walking
• Cycling
• Strength training
• Step exercises
• Gym-based exercise
• Other suitable activities

The programme should be adapted to the respiratory condition and current physical ability.

Pulmonary rehabilitation

Some people with chronic respiratory conditions may benefit from a structured pulmonary rehabilitation programme.

Pulmonary rehabilitation generally combines:

• Exercise
• Strengthening
• Education
• Strategies for managing breathlessness
• Support with maintaining physical activity

It is particularly relevant when breathlessness limits walking and normal everyday activities.

Respiratory physiotherapy may form part of this wider rehabilitation approach.

Building walking tolerance

Breathlessness can gradually reduce how far someone feels comfortable walking.

Rehabilitation may start with a manageable distance and gradually build from there.

Progress may involve:

• Longer walking periods
• Additional repetitions
• Increased distance
• Outdoor walking
• Gentle slopes
• Different surfaces

The amount of progression should reflect symptoms and overall health.

Using stairs

Stairs can cause greater breathlessness than walking on level ground because they require more muscular effort.

Treatment may include:

• Leg strengthening
• Step exercises
• Pacing
• Breathing control
• Practising an appropriate stair rhythm

If you regularly need to stop halfway, rehabilitation may work on both physical capacity and how you manage breathing during the activity.

Pacing everyday activities

Trying to complete physically demanding tasks quickly can increase breathlessness.

Pacing may involve:

• Slowing down
• Breaking larger tasks into smaller sections
• Planning rest periods
• Avoiding unnecessary rushing
• Alternating demanding and lighter activities

This can be useful during activities such as:

• Dressing
• Showering
• Cooking
• Cleaning
• Shopping
• Walking
• Using stairs

Pacing does not mean avoiding activity. It is a way of making activity more manageable.

Strength and respiratory health

People often focus only on the lungs when breathlessness is present.

However, muscle strength also affects how demanding an activity feels.

Weak leg muscles require a greater proportion of your available effort during walking or stairs.

Strengthening may therefore help make everyday movement more efficient.

Exercises can be adapted according to your respiratory symptoms and current ability.

Recovery after a chest infection or pneumonia

A significant respiratory infection can temporarily reduce strength, endurance and confidence.

Even after the infection has improved, you may continue to notice:

• Fatigue
• Breathlessness
• Reduced walking distance
• Weakness
• Difficulty returning to exercise

Rehabilitation may begin with gentle activity and gradually rebuild physical capacity.

If respiratory symptoms are worsening rather than improving, further medical assessment may be required.

Rehabilitation after hospital admission

A prolonged hospital stay can lead to significant loss of strength and fitness.

After discharge, everyday activities may feel considerably harder.

Rehabilitation may focus on:

• Walking
• Standing from a chair
• Strengthening
• Balance
• Using stairs
• Gradually increasing activity

Respiratory symptoms and general physical recovery can be addressed together.

Respiratory physiotherapy around surgery

Some people may receive respiratory physiotherapy before or after surgery, particularly where the operation or medical condition increases the risk of breathing or chest-clearance difficulties.

Treatment may include:

• Breathing exercises
• Supported coughing
• Early movement
• Walking
• Positioning
• Airway clearance where required

The programme depends on the operation and instructions from the surgical team.

Fatigue and respiratory conditions

Living with breathlessness can make normal movement more tiring.

Fatigue may also increase following illness or periods of reduced activity.

Rehabilitation can help identify a manageable level of activity and gradually build physical capacity.

This may involve balancing:

• Walking
• Exercise
• Household tasks
• Work
• Rest

The goal is to avoid both prolonged inactivity and repeated overexertion.

Returning to everyday activities

The purpose of respiratory rehabilitation is to make normal life more manageable.

Your goals may include:

• Walking further
• Using stairs
• Shopping
• Cooking
• Showering independently
• Walking outdoors
• Travelling
• Returning to work
• Exercising
• Returning to hobbies

Treatment can gradually become more specific to these activities.

Returning to work

Respiratory symptoms can affect both physical and desk-based jobs.

Challenges may include:

• Walking around the workplace
• Using stairs
• Lifting
• Prolonged standing
• Talking while moving
• Commuting
• Fatigue

Rehabilitation can help improve physical capacity and develop strategies for managing breathlessness during the working day.

A gradual return may sometimes be appropriate after significant illness.

Returning to exercise

If breathlessness or illness has kept you away from exercise, returning should usually be gradual.

Depending on your condition, you may work towards:

• Walking
• Cycling
• Gym training
• Swimming
• Exercise classes
• Other recreational activity

The starting level may be considerably lower than your previous routine.

Progress can then be based on how your breathing and general health respond.

Using inhalers and respiratory medication

Physiotherapy does not replace prescribed respiratory medication.

Continue using inhalers, oxygen or other treatments according to your medical team's instructions.

Respiratory physiotherapy can work alongside medical treatment by addressing areas such as:

• Breathing control
• Airway clearance
• Exercise
• Mobility
• Physical conditioning

Questions about changing medication should be discussed with the appropriate medical professional.

Oxygen and rehabilitation

Some people with respiratory conditions use prescribed oxygen.

Physiotherapy and exercise may still be possible, but any oxygen prescription and flow-rate instructions should be followed carefully.

Do not independently change prescribed oxygen settings as part of an exercise programme.

Where oxygen requirements or symptoms change, medical review may be needed.

When symptoms change

Respiratory conditions can fluctuate.

You may have periods when breathing or mucus production becomes noticeably worse.

A significant change may include:

• Increasing breathlessness
• More coughing
• Changes in the amount or appearance of mucus
• Fever
• Reduced ability to complete usual activities
• Feeling generally unwell

Depending on your condition, these changes may require assessment by your GP or respiratory medical team.

When urgent medical assessment may be needed

Seek urgent medical assessment for symptoms such as:

• Severe or rapidly worsening breathlessness
• New significant chest pain
• Coughing up a significant amount of blood
• Fainting or loss of consciousness
• Blue or grey colour around the lips or skin
• Severe difficulty speaking because of breathlessness
• Sudden confusion
• A significant and unexplained deterioration in breathing

These symptoms should not be managed through breathing exercises alone.

Working with other healthcare professionals

Respiratory physiotherapy often forms one part of a wider treatment plan.

Depending on your condition, care may involve:

• Respiratory doctors
• GPs
• Specialist respiratory nurses
• Physiotherapists
• Occupational therapists
• Dietitians
• Pharmacists
• Other relevant healthcare professionals

Physiotherapy primarily focuses on breathing techniques, airway clearance, movement and physical rehabilitation.

Treatment based on your goals

Respiratory symptoms affect people differently.

Your goals may include:

• Becoming less limited by breathlessness
• Clearing mucus more effectively
• Walking further
• Managing stairs
• Becoming stronger
• Returning to work
• Exercising again
• Recovering after illness
• Managing everyday activities independently
• Understanding how to manage your breathing more effectively

Your programme can be developed around these practical goals and reviewed as your symptoms change.

How long does respiratory physiotherapy take?

There is no single timeline.

The amount of physiotherapy required depends on:

• The respiratory condition
• Current symptoms
• Strength and fitness
• Whether mucus clearance is required
• Recent illness or hospital admission
• Other medical conditions
• Your rehabilitation goals

Some people may need only a small number of appointments to learn a breathing or airway-clearance technique.

Others may benefit from a longer rehabilitation programme to improve mobility, strength and exercise tolerance.