PHYSICAL THERAPY AND REHABILITATION



Chest physiotherapy (percussion and postural drainage) is employed on the assumption that sputum retention has undesirable consequences. While this is a reasonable although unproved as­sumption and while physiotherapy increases the immediate volume of sputum cleared, there is no evidence that it affects the natural history of any disease. Similarly, breathing training and exercise rehabilitation lack a clear scientific basis. How­ever, patients with pulmonary disease of suffi­cient severity to prevent normal daily living com­monly demonstrate an improved quality of life when enrolled.in a properly run rehabilitation Drosram Finally, nutritional needs in these pa­tients must be addressed. This is important m cys­tic fibrosis, as supplemental pancreatic enzymes and vitamins are necessary. However, the debi­litated patient with emphysema must also be con­sidered for nutritional support, since poor nutri­tion may render him susceptible to respiratory failure through decreased muscle strength.