Definition

Asthma is a chronic inflammatory disease of the airways characterized by reversible airway obstruction and bronchial hyperresponsiveness. It leads to episodes of wheezing, coughing, chest tightness, and shortness of breath. *Pathophysiology Trigger exposure (allergens, cold air, exercise, etc.) → Airway inflammation → swelling of mucosa Bronchospasm → tightening of airway smooth muscles Excess mucus production → airway obstruction Results in narrowed airways → reduced airflow and difficulty breathing Key feature: The obstruction is reversible, either spontaneously or with treatment. *Clinical Features (Symptoms) Coughing (often worse at night or early morning Wheezing (whistling sound while breathing) Shortness of breath (dyspnea) Chest tightness Anxiety or restlessness during attacks

Diagnosis History and symptoms Spirometry: ↓ FEV₁ (forced expiratory volume in 1 sec), reversible after bronchodilator Peak Expiratory Flow Rate (PEFR): Used to monitor severity Allergy testing if triggers suspected Medical Management Bronchodilators: Short-acting beta-agonists (SABA) → salbutamol Long-acting beta-agonists (LABA) → formoterol, salmeterol Anti-inflammatory drugs: Inhaled corticosteroids (ICS) → budesonide, fluticasone Leukotriene receptor antagonists: e.g., montelukast Oxygen therapy during acute attacks (if needed) Physiotherapy Management in Asthma Goals of Physiotherapy Improve ventilation and oxygenation Facilitate airway clearance Reduce work of breathing Teach breathing control and relaxation Improve exercise tolerance and overall fitness Educate the patient for self-management

1. During Acute Attack (Severe Phase) Note: During a severe attack, physiotherapy is limited — medical stabilization takes priority. Once the patient is stable: Breathing Control Position: High sitting or forward-leaning (“tripod position”) for easier breathing. Pursed-lip breathing: Inhale through the nose → exhale slowly through pursed lips. Helps reduce airway collapse and control breathlessness. *Relaxation Techniques Gentle shoulder and neck relaxation to reduce accessory muscle tension. Encourage calm, slow breathing to reduce anxiety

2. Post-Acute Phase (Recovery Stage) Airway Clearance Techniques To remove mucus and improve ventilation: Active Cycle of Breathing Technique (ACBT) Breathing control (gentle relaxed breathing) Deep breathing exercises (thoracic expansion) Huffing or forced expirations to clear secretions Autogenic drainage (advanced technique to mobilize secretions) Postural Drainage Drain different lung segments by using gravity (only if sputum is excessive). Avoid if patient feels dizzy or uncomfortable.

3. Breathing Exercises Diaphragmatic breathing: Patient lies supine or sits upright. Inhale deeply using diaphragm (abdomen rises), exhale slowly. Segmental breathing: Hands placed over lower ribs → patient breathes into that area to improve chest expansion. Thoracic expansion exercises: Deep inspiration → hold 2–3 seconds → relaxed expiration.

4. Exercise Training Purpose: Improve cardiovascular fitness and reduce dyspnea. Aerobic exercises: Walking, swimming, cycling — start gradually. Frequency: 3–5 times per week, 20–40 min/session. Use interval training initially (short bouts with rest). Include warm-up and cool-down phases to prevent exercise-induced asthma.

5. Posture Correction Avoid rounded shoulder posture that restricts chest expansion. Strengthen postural muscles (scapular retractors, spinal extensors).

6. Relaxation & Stress Management Yoga and meditation help control breathing rhythm and anxiety. Progressive muscle relaxation for overall calmness.

7. Patient Education Explain disease process and triggers. Teach inhaler technique properly. Emphasize importance of medication compliance. Encourage self-monitoring using peak flow meter. Identify early signs of attack and emergency action plan. Encourage hydration and regular exercise. Sample PT Protocol PhaseFocusKey Physiotherapy InterventionsAcuteBreathing control, relaxationPursed-lip breathing, positioningSubacuteAirway clearance, expansionACBT, diaphragmatic breathingChronicStrength, enduranceAerobic training, posture correctionMaintenancePreventionLifestyle & trigger management

Prognosis With medication + physiotherapy, most patients lead a normal active life. Regular physiotherapy improves lung function, reduces attacks, and enhances quality of life. Written by : Dayana K O PHYSIOTHERAPIST