Gemma Stanford, specialist physiotherapist in adult cystic fibrosis, Royal Brompton Hospital

Can you describe what you do day-to-day? 

I am a specialist physiotherapist working in the Royal Brompton Hospital team caring for adults with cystic fibrosis. Every day is different! As a physiotherapist, my role includes working with individuals to create and optimise treatment plans, including exercise programmes, inhaled medication management and sputum clearance exercises.

At the start of the day, we sit down as a cystic fibrosis (CF) physio team and discuss the patients who need to be seen that day.

We see people in clinics, on the wards and via virtual assessments, and the problems we help to solve range from how patients can best use oxygen so they are able to walk to the shops to advising patients who might be training for a marathon.

Can you discuss the work you do with CF patients?

There are lots of different things that we do as CF physiotherapists.

People with cystic fibrosis often produce thick and sticky sputum (a thick type of mucus) which can lead to breathing problems, lung infections and lung damage if not cleared. So, part of our role as CF physiotherapists involves teaching sputum clearance techniques such as breathing exercises to help patients manage their sputum and reduce the risk of infections.

We also advise patients on different types of physical exercises to help keep their chests clear and to maintain general fitness levels, as well as recommend treatments for muscle or joint issues. Exercise can also help with other issues CF patients might experience, like incontinence, which can result from coughing.

Can you describe some of your CF research?

The CF team is very research active, and I have been lucky to work on some interesting projects. My first big project was an investigation into whether the addition of non-invasive ventilation (NIV) to aid deep breathing during sputum clearance exercises was better than the sputum clearance exercises alone - we found that they were similar, which helped us to be able to use NIV with some patients who benefited from its support. 

I was awarded a National Institute for Health Research (NIHR) Fellowship to investigate the best ways to measure the effects of sputum clearance techniques; it will help us evolve our practice for the future, which is exciting! We have just completed this study and are analysing the results. I am very grateful to all the adults with CF who helped me with this work, especially with disruptions due to the COVID-19 pandemic. 

What do you like most about your job?

Hard question! Two things - the people (the CF team and the people with CF who work with us) and the variety (research, patient care and networking).

What have been some of the highlights in your role to date?

I have had this role for over 15 years! There are a lot of highlights - personal gains for adults with CF who we have helped live their lives the way they wanted; my research fellowship; being able to network and being recognised internationally as a CF physio. I recently became the chair of the European Cystic Fibrosis Society's Physiotherapy Specialist Interest Group, which has opened doors of communication with international colleagues. 

Which part of your job is most challenging?

​CF can be a tough disease, and sometimes it limits what people who have CF can do and can end their lives prematurely - all we can do as a CF team is do our best to problem solve and help all people with CF live their lives as best they can. 

Why did you decide to work for the NHS/ how did you become a specialist CF physiotherapist?

I was accident-prone as a teenager and met a lot of physiotherapists! I fancied doing their job — although, at the time, I thought it was all about helping people with broken bones — and so applied to train as a physio. During training, physiotherapists must complete placements in different hospitals and in various areas of healthcare. I had a great placement in an intensive care unit and realised I really liked helping people recover from being in intensive care, especially people with breathing problems.

I got my first job and completed several months in different areas of physiotherapy, but I still really liked helping people with breathing problems the best. That's where I heard about Royal Brompton Hospital. Rumour had it that it was the best hospital for breathing problems, so I decided I needed to work there. I applied for the next available job and moved to London. Once at Royal Brompton Hospital, I had a placement on the cystic fibrosis ward. I loved the job, and the rest is history!