As a part of your Home IV treatment, you will be offered comprehensive physiotherapy support. This service will be provided online or by telephone and is available for the duration of your IV treatment.
Please find further resources and FAQs below.
Frequently Asked Questions
During a flare up (exacerbation) of your lung condition, it is likely that your chest symptoms may feel worse. Common symptoms include bringing up excess sputum (phlegm, mucus) coughing more, feeling breathless and struggling to get up and move around. The degree of symptoms varies with each individual.
Chest physiotherapy involves a range of exercises and techniques that can help clear excess sputum from the airways and improve lung function and breathing. The physiotherapy team can support you by giving you useful guidance about managing your symptoms through breathing exercises and airway clearance techniques to help your chest recover as quickly as possible.
During your visit to the Day Case Unit to start Home IV treatment, you will also be assessed by the physiotherapy team. This assessment will include a discussion about your symptoms, a review of airway clearance techniques, and a review of your physical activity level. This will help us assess how best we can support you.
Additionally, the physiotherapy team aim to provide you with support about recovering your physical activity levels via an assessment from our exercise practitioner.
Following your assessment, the physiotherapist will create a tailored physiotherapy treatment plan for you, which can be followed from the comfort of your home, and with online or telephone support from the team if needed.
The amount of one-to-one support you receive will vary depending on your needs and will be confirmed to you by the physiotherapy team.
Our physiotherapists and exercise practitioners are keen to help support and guide you during your Home IV treatment in any way they can. We are aware of how these treatments can improve your recovery and want to work with you on the best way to achieve this, alongside recovering from your infection.
At the end of your Home IV treatment, the team will discuss with you about whether any follow up treatments or referrals are required.
During your physiotherapy sessions, you will be given exercises to help you with clearing your chest. These will be a range of breathing exercises which may or may not include breathing devices.
You will be given guidance on your physical activity levels and useful tips on how to keep yourself well during and after your treatment.
You will be offered the chance to talk through these options with the physiotherapy team once you are at home, via telephone or video call (if we need to see the exercises being performed) throughout your treatment.
Finally, we will also discuss how to fit these exercises into your daily routine alongside your other treatments, and work with you on the best ways to complete these exercises.
Physiotherapy antibiotic advice for patients on Home IV treatment
What is an exacerbation?
An exacerbation is a flare up of your lung condition, where your condition can worsen and is usually caused by a chest infection. During an exacerbation it is likely that your chest symptoms may feel worse. Common symptoms include a change in the colour, thickness and quantity of your sputum, as well as coughing more, feeling breathless and struggling to get up and move around. The degree of symptoms varies with each individual.
Sputum (mucus, phlegm, secretions)
When you have an exacerbation, the amount of sputum you produce may increase, it may also change colour and become thicker making it more difficult to clear. When you are taking medication for an infection it is essential for you to keep your chest as clear as possible to give the treatments the best chance of working. This is because if sputum is trapped in your airways, it can cause inflammation and provide an ideal environment for bacteria (germs) to thrive. The clearer your chest is, the more likely it is for treatments to work.
Airway clearance techniques
Airway clearance techniques can help loosen sputum from the lungs so it can be cleared from the airways and improve lung function and breathing.
There are various airway clearance techniques patients can use, but these will be tailored for each individual to ensure the technique is suited to their needs. Some techniques include breathing exercises alone and others use a device alongside the breathing exercise. You will be taught the technique that is best suited to your needs by a specialist physiotherapist.
If you have already been taught an airway clearance technique and regime before this exacerbation, these techniques may need to be adapted whilst you are currently unwell to ensure they are as effective as possible in clearing your chest.
It is essential that you contact your physiotherapist if you are struggling to clear your chest or are unable to perform the airway clearance techniques. Please see the ‘Contact us’ section below to contact the physiotherapy team.
Hydration
It is essential you keep hydrated and drink plenty of fluids during an exacerbation. Being dehydrated can affect your sputum and cause it to become thicker and stickier. Your airways can also become dry, making it harder for sputum to clear, causing an irritable cough in some people. If you are unable to clear your sputum effectively this can lead to your antibiotic therapy not working, as well as possibly worsening your cough, and/or worsening your shortness of breath.
Drinking plenty of fluids, including water and decaffeinated drinks is important and you should aim to drink 1.5-2 litres of water a day. You may be prescribed saline or salty saline (MucoClear, Nebusal) to take in a nebuliser (a device that allows you to breathe in medication through a mask or mouthpiece). This can be helpful if your sputum is very thick and sticky. This should be done before you do your airway clearance techniques. Please talk to your physiotherapist about this.
Medications
Patients who use inhalers and nebulisers need to know what order to take their inhalers and nebulisers in line with their physiotherapy airway clearance techniques. As a general rule of thumb, you should take your inhaler and/or nebulisers (medicines that open your airways) first (such as a salbutamol inhaler (commonly known as Ventolin) and/or ipratropium bromide (commonly known as Atrovent). You should then take your saline (Mucoclear) or salty saline (Nebusal) medications before completing your airway clearance, and as prescribed by your physiotherapist. Following this, you can take your preventer and steroid inhalers and/or nebulised antibiotic (such as Fostair, Trimbow, and/or Colomycin).
Remember to ‘LIFT’
- Loosen: Keeping hydrated is essential and has a direct impact on your secretions, so it is essential to drink plenty of fluids. If your secretions are very thick or sticky, then you may be advised to take a nebuliser with saline (MucoClear) or salty saline (Nebusal) to help loosen these secretions. Please ask your physiotherapist for advice if you are unsure.
- Inhalers: Some patients may be on medications to open up their airways e.g. a blue inhaler (Ventolin). It may be important to use this before your airway clearance (with advice from your medical team and physiotherapist).
- Frequency: Increase the frequency of your airway clearance regime e.g. once a day to twice a day.
- Time: Increase the length of your airway clearance e.g. from 10 minutes to 20 minutes until your cough is clear or you require a rest.
Recovery and exercise
When you are unwell, it is important to rest and allow yourself time to recover. Having enough energy is important to enable you to clear your chest. However, some daily activity is helpful and will aid your recovery. Physically moving around helps with airway clearance as the air will move in and out your chest more quickly which can help to break up and clear the sputum.
Activity can also help with mood and mental health. After a few days of your medications, if you start to feel better, it is good to start doing some physical activity. This could include gentle low impact exercise like walking, yoga, stretching etc. If you are normally very physically active, you may feel you can manage more than this.
Whatever exercise/activity you choose to do, start at a lower level than what you are used to, building up slowly over time. Your exercise/activity should be comfortable, and easy to recover from. You should stop if you experience chest pain, feeling faint or unexpected breathlessness. You should always seek advice if unsure.
Please see the ‘Contact us’ section below to contact the physiotherapy team.
What to do if I feel unwell or I don’t feel like I am getting better?
If you feel unwell or don’t feel like you are getting better, contact the relevant clinical team on the numbers below as soon as possible. In an emergency call 999 for an ambulance or go to your nearest emergency department (A&E).
| Cystic Fibrosis (CF) clinical nurse specialist (CNS) | Telephone: 020 7351 8065 Email: cfhomecare@rbht.nhs.uk |
| CF out-of-hours | Bleep 1097 / 1099 (from switchboard) |
| Host defence infection team and primary ciliary dyskinesia (PCD) CNS | Bleep 1005 (from switchboard) Host defence email: HostDefence@rbht.nhs.uk PCD email: AdultPCD@rbht.nhs.uk |
| Interstitial lung disease (ILD) CNS | Mobile: 07891 583 141 Email: ILD@rbht.nhs.uk |
Speak to the physiotherapy team
If you feel like you are struggling to clear your chest then it is important to discuss this with the physiotherapy team. You will hopefully have been assessed on day one of your antibiotic courses and may have also received some follow up. However, if you feel like your chest is not clearing or physiotherapy is difficult due to breathlessness, wheezing, chest pain or thick secretions then please seek advice from the team, as per the ‘contact us’ section.
Follow up after your treatment
Some patients may not require a follow up and going back to your usual airway clearance and exercise is advised. Sometimes it will be necessary to have a follow up after a few months to see how things are progressing. This is especially important if you notice your infection frequency has increased or if your airway clearance is difficult to remember or complete. Physiotherapists can help to ensure you have the best tool kit to look after your condition long term. You may benefit from pulmonary rehabilitation following an exacerbation to improve your fitness.
Contact the physiotherapy team
We are offering drop-in video consultations for patients in our Home IV physiotherapy clinic through our video platform, Attend Anywhere.
Patients can drop-in for a video consultation between 9am and 11am, Monday to Friday via the following link: https://nhs.vc/RBH-HomeIV
When you click on the link you will be asked to enter the Home IV physiotherapy waiting area where someone from the team will join you when they are ready. If you are unable to access the Attend Anywhere system, please call the physiotherapy team on extension 88088 via the switchboard.
Find out more about the Attend Anywhere video platform.