Respiratory Physiotherapy: Lung Conditions

Respiratory Physiotherapy: Pulmonary Rehabilitation

Respiratory physical therapy helps people with lung disease manage their breathing more effectively and resume their daily activities. Chronic respiratory diseases can make it difficult to walk, perform household chores, or get dressed. Physical therapy can be part of a pulmonary rehabilitation program that also focuses on endurance, strength, and quality of life.

Services at Physioactif: Respiratory physical therapy is not offered at Physioactif. To access a pulmonary rehabilitation program, ask your doctor which service to contact. This article explains this area of care and the benefits observed in studies.

Pulmonary rehabilitation can help people with chronic obstructive pulmonary disease (COPD), a condition that causes long-term limitations in airflow in the lungs. It can also help some people with asthma, cystic fibrosis, or respiratory problems following COVID-19. The programs combine supervised exercise, education, and breathing techniques, as needed.

After hospitalization for a worsening of COPD—known as an exacerbation—pulmonary rehabilitation improves exercise capacity and quality of life, while reducing readmissions¹. Some programs are available remotely. This telerehabilitation can reduce travel, but access depends on the program and the individual’s needs.

What is respiratory physiotherapy?

Respiratory physical therapy uses exercises, breathing techniques, and guidance to help a person breathe better and carry out daily activities. Pulmonary rehabilitation is a broader program: a team evaluates the person and then tailors exercises, education, and support to their physical and psychological health². The program may therefore focus on the lungs, but also on muscles and endurance.

The American Thoracic Society, a medical organization dedicated to respiratory health, published guidelines in 2023. These guidelines strongly recommend pulmonary rehabilitation for stable COPD—without a current acute exacerbation—following hospitalization for a COPD exacerbation and for interstitial lung diseases³. These conditions affect the tissue surrounding the small air sacs in the lungs.

Respiratory physical therapy is one of the areas of practice within physical therapy. Musculoskeletal physical therapy focuses on muscles, bones, joints, and related structures. These areas can overlap: a person with a respiratory condition may also need to strengthen their legs or improve their ability to walk.

The team may include pulmonologists, physical therapists, respiratory therapists, psychologists, nutritionists, and social workers². Services may be provided in the hospital, at an outpatient clinic, or at home. The team selects the necessary equipment and monitoring based on the patient’s condition, exercise capacity, and other health issues.

What conditions are treated in pulmonary rehabilitation?

Pulmonary rehabilitation can help people with COPD, asthma, cystic fibrosis, post-COVID-19 complications, interstitial lung diseases, or pulmonary hypertension. Pulmonary hypertension is characterized by abnormally high pressure in the blood vessels that carry blood to the lungs. Originally developed for COPD, these programs have been expanded to include other conditions, with evidence and goals that vary depending on the diagnosis².

COPD (Chronic Obstructive Pulmonary Disease)

COPD is the condition for which the benefits are best documented. The U.S. guidelines strongly recommend rehabilitation for adults with stable COPD—that is, without any sudden worsening of symptoms³. The evidence provides moderate confidence in this recommendation.

A review of 17 studies reports fewer readmissions when rehabilitation begins within three weeks of hospital discharge due to an exacerbation of COPD. The finding on readmissions comes from 12 studies involving 1,309 people: the odds ratio is 0.48, a measure that compares readmissions to non-readmissions in each group. This result indicates a decrease, but does not mean that the risk is halved¹. The distance covered on the six-minute walk test increased by an average of about 57 meters more than in the control groups, which received usual care without this program¹. This average gain is large enough to be clinically significant, but it does not predict the outcome for each individual.

The British guideline cited in StatPearls recommends beginning rehabilitation within one month of discharge from the hospital following a flare-up². The team first verifies that the patient’s health status allows them to participate in the program.

Asthma

Asthma causes varying degrees of narrowing and inflammation of the airways. Medications remain important for controlling the condition. In adults, a Cochrane review of 10 studies shows that rehabilitation likely improves walking capacity and certain quality-of-life scores at the end of the program, compared with usual care. Its effect on asthma control is smaller or uncertain, depending on the measure used.

Exercise can be part of asthma management, with a tailored program and a plan for responding to symptoms. Some people become short of breath or experience wheezing during physical activity. The healthcare professional will then adjust the activity and check with the medical team to ensure the condition is under control. Breathing techniques can also help manage persistent shortness of breath and the panic that accompanies it, as explained in this hospital fact sheet on breathing.

Cystic Fibrosis

Cystic fibrosis is a genetic disorder inherited from parents that, among other things, causes mucus—the protective fluid in the airways—to become thicker and harder to clear. Clearance techniques are used to move this mucus toward the mouth. A Cochrane review examined several approaches⁴ : manual chest therapy, active breathing cycles, autogenic drainage, positive expiratory pressure (PEP) devices, oscillating devices, and exercise⁴. The techniques and their procedures are explained below.

Active breathing techniques can be combined with a PEP device, which provides resistance when the person exhales⁵. The choice depends on the results achieved, comfort, and ease of use; this combination has not been shown to be superior for everyone. In cystic fibrosis, mucus clearance is part of long-term care—often performed daily—and should be tailored in consultation with the healthcare team. Studies comparing these techniques to no treatment or coughing alone show a possible benefit in mucus clearance in the short term. They do not allow for conclusions about long-term effects and predate the widespread use of newer medications that alter the course of the disease⁶.

Post-COVID Conditions

After COVID-19, some people continue to experience shortness of breath, fatigue, or reduced exercise tolerance for several months. These symptoms may be part of long COVID. An evaluation helps determine their possible causes and the appropriate care.

A 2025 review compiled 37 studies on COVID-19-related rehabilitation. It found benefits in exercise capacity, certain pulmonary measures, quality of life, fatigue, and anxiety, compared with various control treatments⁷. The programs sometimes combined breathing exercises, walking, and strength training. Not all studies included participants at the same stage of recovery: some focused on the initial illness, while others addressed persistent symptoms. Programs lasting four to eight weeks showed several favorable outcomes, but this does not establish a specific recovery timeline or the ideal duration for each individual⁷.

For some people, even light exertion can worsen symptoms later on, often within the next 12 to 72 hours. This worsening of symptoms after exertion can last several days. The program should therefore help individuals pace their activities and breaks according to their symptoms; it should not require a continuous increase in exercise.The World Health Organization also recommends screening for and managing exercise-induced oxygen desaturation and heart problems before beginning physical training after COVID-19.

A 2024 study assigned 35 students aged 19 to 30—who were still experiencing symptoms after COVID-19—to either a home-based exercise program or a control group. After four weekly sessions over four weeks, the exercise group showed greater improvement in forced expiratory volume in one second (FEV1) and its proportion relative to total expiratory volume. Differences in other respiratory measures and fatigue were not clear between the groups⁸. This result does not support the claim that these exercises alone can reduce fatigue.

A study conducted in China followed people aged 65 and older after acute care for COVID-19. Of the 72 people who completed the study, 36 had undergone six weeks of rehabilitation consisting of two 10-minute sessions per week and daily exercises at home. Their breathing, endurance, quality of life, and anxiety levels had improved more than those of the group that did not undergo rehabilitation. The study did not show a clear benefit regarding depression or daily functioning.⁹

Other Conditions

The U.S. guidelines strongly recommend pulmonary rehabilitation for interstitial lung diseases. They also suggest it for pulmonary hypertension, though with greater uncertainty and a decision that should be tailored to the individual³. These programs are also used before and after a lung transplant, a surgical procedure that replaces a diseased lung with a donor lung.

What breathing techniques are used?

Respiratory physical therapy uses techniques such as the active breathing cycle, autogenic drainage, PEP and oscillating devices, diaphragmatic breathing, and pursed-lip breathing. Some techniques are used to clear mucus; others help manage shortness of breath. The therapist will select and teach you the techniques that best meet your needs.

The active breathing cycle alternates between calm breaths, deeper inhalations, and exhaling through an open mouth, as if to fog up a window. This exhalation, called a “huff,” helps bring mucus up. Coughing can then clear it away¹⁰. The healthcare professional will teach you how to pace your movements without tightening your throat or straining excessively.

Autogenous drainage uses breaths of varying sizes to move mucus from the small airways to the larger ones. The person starts with small volumes of air and then increases the volume as the secretions move. This technique is learned with a healthcare professional and can then be practiced without a device.

PEP therapy, or positive expiratory pressure, uses a device that creates resistance as you exhale. This pressure helps keep the airways open and clear mucus. Your healthcare provider will select the device and set its parameters, then teach you how to use and maintain it at home⁵.

Oscillating devices, such as Flutter and Acapella, add vibrations to the resistance as you blow. They can help loosen mucus. These portable devices are part of the at-home treatment program; they do not replace other prescribed treatments.

Diaphragmatic breathing engages the diaphragm, the large muscle beneath the lungs. In a comfortable position, place one hand on your abdomen, relax your shoulders, and let your abdomen move gently with your breath, without trying to take deep breaths. Pursed-lip breathing involves inhaling through the nose—if that remains comfortable—and then exhaling gently through pursed lips. It slows the exhalation and can give the lungs more time to empty. These techniques for managing shortness of breath are intended for stable shortness of breath; new or worsening breathing difficulties require medical attention.

For cystic fibrosis, comparative studies do not allow us to identify a single mucus-clearance technique that would be superior for everyone. The evidence is very uncertain¹¹. This does not mean that all methods are equally effective. The choice depends on the individual’s preferences, training, comfort level, and the observed results.

How does a pulmonary rehabilitation program work?

A pulmonary rehabilitation program combines an assessment, tailored exercises, education about the condition, and—as needed—support for psychological well-being, social challenges, or nutrition. Care can be provided in the hospital, on an outpatient basis, at home, or remotely.

Program Components

Exercise training is a central component². It includes endurance activities, such as walking or cycling, strength training, and flexibility exercises. The professional tailors the intensity, rest periods, and progression to the patient’s health and response to exercise. Our guide outlines general principles for exercise progression, which should be adapted to the respiratory program.

The team explains the condition to you, the signs of worsening symptoms, how to take your medications, and the action plan developed with your healthcare providers². The goal is to know what to do on a daily basis and when to ask for help.

Psychological and social support helps manage anxiety, depression, and difficulties related to the illness². Living with constant shortness of breath can be distressing. The team offers coping strategies and support from others in similar situations.

Nutritional guidance helps prevent or manage weight loss and muscle mass loss, which can occur with severe COPD². Eating enough helps maintain the strength needed for exercise and daily activities. The dietitian assesses energy and protein needs and then suggests strategies for when shortness of breath makes eating difficult.

Duration and Frequency

In studies of stable COPD, the majority of programs lasted between eight and twelve weeks³. Compared with usual care, the average gain on the six-minute walk test was approximately 44 meters; it was approximately 57 meters following hospitalization for exacerbation. Quality-of-life scores on the St. George questionnaire improved by an average of approximately 7 and 9 points, respectively³. This questionnaire measures the impact of symptoms on daily activities and life. These average gains exceed the thresholds typically considered clinically meaningful for patients, though they do not guarantee the same outcome for everyone.

The frequency and duration of sessions vary depending on the program and your health. After initial rehabilitation, the team encourages you to continue with regular, appropriate physical activity. A supervised maintenance program may improve certain aspects of quality of life, but its additional benefits regarding walking or shortness of breath remain uncertain. The guide therefore recommends either this follow-up program or usual care, depending on your needs and preferences³. The ideal frequency of supervision has not been established.

Delivery Methods

Rehabilitation can take place on an outpatient basis or in a hospital setting under direct supervision. The evaluation determines the level of monitoring required during exercises.

Telerehabilitation telerehabilitation allows patients to complete part or all of the program remotely. The U.S. guidelines recommend offering adults with stable chronic respiratory disease the choice between in-person and telerehabilitation³. The studies supporting this recommendation almost exclusively concern COPD.

Telerehabilitation can reduce the need for travel and make it easier to participate. However, it requires appropriate organizational arrangements, sometimes an Internet connection, and the ability to use the equipment. Barriers to access persist: few of the people who could benefit from rehabilitation actually participate in it.

Hybrid programs combine in-person and remote sessions. They allow participants to maintain direct contact while offering greater flexibility for certain sessions.

When to seek respiratory physiotherapy?

An evaluation for pulmonary rehabilitation is helpful when shortness of breath or fatigue related to a lung condition limits your activities despite the care you’re receiving². After a hospital stay, be sure to discuss this with the team coordinating your discharge home. New or worsening symptoms must first be medically evaluated; exercise is not a substitute for this evaluation.

Difficulty getting dressed, doing housework, or walking; persistent fatigue; repeated hospitalizations; or a reduced quality of life may be reasons to have this discussion. The team will determine the causes of these limitations and assess whether the program is right for you.

Call 911 or go to the emergency room if you’re having a lot of trouble breathing, if you’re choking, or if you can no longer speak normally. A tight or heavy feeling in the chest, pain that spreads to the arm, back, neck, or jaw, lips or skin that become very pale, blue, or gray, or sudden confusion also require immediate help. Do not drive yourself.

Seek immediate medical attention if you experience difficulty breathing or shortness of breath that is more severe than usual, nausea or vomiting, blood in your sputum, pain or swelling in a leg, or an unusual heartbeat. These symptoms, as described by the British health service, should not be ignored until your next rehabilitation appointment.

In Quebec, your doctor can refer you to a program based on your region and your condition. The Montreal Chest Institute at the McGill University Health Centre (MUHC) describes its pulmonary rehabilitation program¹². The Montreal framework also includes the University of Montreal Hospital Center (CHUM), the public health networks of the North and Central-West regions of the Island of Montreal, and the Quebec Lung Association. Please contact the program directly to confirm locations, admission criteria, and wait times.

At Physioactif: Respiratory physical therapy is not offered. This decision does not mean that all respiratory care requires hospitalization. The program must have a team and level of supervision appropriate for your health. Our guide outlines the different areas of physical therapy to help you understand their goals.

Public physical therapy services are generally covered by the RAMQ, the Quebec Health Insurance Board. In Montreal, the brochure for participants states that the pulmonary rehabilitation program is free. Wait times and eligibility requirements depend on the service and your situation.

What are the frequently asked questions about respiratory physiotherapy?

Frequently asked questions cover the services offered at Physioactif, access in Quebec, costs, duration, benefits, remote care, and who can benefit from these services. The following answers highlight how the respiratory program differs from the services offered by our clinic.

Is respiratory physiotherapy offered at Physioactif?

Respiratory physical therapy is not offered at Physioactif. A pulmonary program combines the expertise and monitoring tailored to a person’s respiratory needs. Our physical therapists work with people who have muscle, bone, and joint conditions, particularly after an injury or surgery. Our guide explains the areas of practice in physical therapy.

Where can you access a program in Quebec?

Your doctor may request a referral to a program in your area. In Montreal, the program at the MUHC Thoracic Institute¹² is one of the resources listed. The CHUM, the public health networks of the North and Central-West regions of the Island of Montreal, and the Quebec Lung Association are also part of the regional network. Check with the department for information on location, eligibility criteria, and wait times.

Is it covered by RAMQ?

Public programs are generally covered by the RAMQ. The Montreal program described in the official brochure is free. A medical referral is required for this program; the team will provide you with details on the procedures and wait times.

How long does a program last?

In studies of stable COPD, most programs lasted between eight and twelve weeks, ranging from four weeks to one year³. The Montreal program, however, is structured around six to ten weeks, with two to three sessions per week. The actual duration is confirmed with your care team. Less frequent maintenance programs may follow³.

What are the proven benefits?

For COPD, the programs improve walking distance, shortness of breath, and quality of life. The average increase in walking distance is about 44 meters when the disease is stable and 57 meters after hospitalization for an exacerbation³. The average improvement on the St. George Quality of Life Questionnaire is approximately 7 and 9 points, respectively³. Following such a hospitalization, rehabilitation also reduces readmissions, although the odds ratio of 0.48 does not indicate that the risk is halved¹. The program can also support emotional well-being³.

Can rehabilitation be done remotely?

Tele-rehabilitation is an option for some people with stable chronic respiratory disease. The U.S. guidelines recommend offering it as an alternative to an in-person program; studies have focused primarily on COPD³. Follow-up can be conducted by phone, via a website, or through videoconferencing. The equipment provided and the level of supervision vary by program. The team will assess whether this option meets your safety and support needs.

Who can benefit from this physiotherapy?

People whose activities are limited by a lung disease may be eligible for an evaluation for this type of care². This includes, in particular, COPD, asthma, cystic fibrosis, interstitial lung diseases, pulmonary hypertension, and certain post-COVID-19 complications. A program may also be provided following a transplant. The team tailors the decision to your condition, symptoms, and goals.

References

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1. Jenkins AR, Burtin C, Camp PG, Lindenauer P, Carlin B, Alison JA, et al. Do pulmonary rehabilitation programs improve outcomes in patients with COPD following hospital discharge for an exacerbation: a systematic review and meta-analysis. Thorax. 2024;79(5):438-447. (Back to sections: 1, 2, 3, 4)
2. Shenoy MA, Paul V. Pulmonary Rehabilitation. [Updated July 25, 2023]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023. (Back to sections: 1, 2, 3, 4, 5, 6, 7, 8, 9, 10)
3. Rochester CL, Alison JA, Carlin B, Jenkins AR, Cox NS, Bauldoff G, et al. Pulmonary Rehabilitation for Adults with Chronic Respiratory Disease: An Official American Thoracic Society Clinical Practice Guideline. Am J Respir Crit Care Med. 2023;208(4):e7-e26. (Back to sections: 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13)
4. Wilson LM, Morrison L, Robinson KA. Airway clearance techniques for cystic fibrosis: an overview of Cochrane systematic reviews. Cochrane Database Syst Rev. 2019;1(1):CD011231. (Back to sections: 1, 2)
5. Chaudary N, Balasa G. Airway Clearance Therapy in Patients with Cystic Fibrosis: Insights from a Clinician Providing Cystic Fibrosis Care. Int J Gen Med. 2021;14:2513-2521. (Back to sections: 1, 2)
6. Warnock L, Gates A. Airway clearance techniques compared to no airway clearance techniques for cystic fibrosis. Cochrane Database Syst Rev. 2023;4(4):CD001401. (Back to section: 1)
7. Li S, Dai B, Hou Y, Zhang L, Liu J, Hou H, et al. Effect of pulmonary rehabilitation for patients with long COVID-19: a systematic review and meta-analysis of randomized controlled trials. Ther Adv Respir Dis. 2025;19:17534666251323482. (Back to sections: 1, 2)
8. Jeong CH, Nam MW, Lee DY, Hong JH, Yu JH, Kim JS, et al. Randomized Controlled Trial on the Effects of Home-Based Breathing Exercises on Respiratory Function and Fatigue in Young Patients Who Have Recovered from COVID-19. Healthcare (Basel). 2024;12(15). (Back to section: 1)
9. Liu K, Zhang W, Yang Y, Zhang J, Li Y, Chen Y. Respiratory rehabilitation in elderly patients with COVID-19: A randomized controlled study. Complement Ther Clin Pract. 2020;39:101166. (Back to section: 1)
10. Respiratory Therapy. Airway-Clearance Techniques. 2007. (Back to section: 1)
11. Main E, Rand S. Conventional chest physiotherapy compared to other airway clearance techniques for cystic fibrosis. Cochrane Database Syst Rev. 2023;5(5):CD002011. (Back to section: 1)
12. McGill University Health Centre. MUHC COPD Clinic Helps Patients Breathe a Little Easier | McGill University Health Centre. (Back to sections: 1, 2)
13. Vitacca M, Paneroni M. Pulmonary rehabilitation guidelines for COPD: Where do we go from here? Expert Review of Respiratory Medicine. 2024;18(11):831-833.
14. Blue Cross and Blue Shield of Texas. Pulmonary Rehabilitation.