Respiratory Assessment: What Happens at the First Appointment?

The decisive stage in respiratory physiotherapy is not the exercise itself but the assessment that precedes it. Applied to breathlessness that has not been properly assessed, even the best-known technique lands at the wrong address.

The purpose of the first appointment is to understand the mechanism behind your complaint. “I can't get enough air” may arise from reduced respiratory muscle strength, air trapping and lung hyperinflation, secretions that cannot be cleared, loss of conditioning, or a disordered breathing pattern. The route taken differs in each case.

The appointment lasts about an hour. It helps to wear clothes you can move in and to bring any lung function tests, chest X-ray or CT reports, medical discharge summaries and a list of your medication.

1. Detailed history

We begin by talking. When the complaint started, what makes it better or worse, what time of day it is most noticeable, whether it disturbs your sleep, at what distance or after how many steps it appears — all of this is recorded in detail, along with smoking history, occupation, previous surgery and other conditions.

The most important question in this section is this: where exactly does breathing stop you in daily life? The goal of the programme is set from that answer. For one person it is walking to the shop in one go, for another lifting a grandchild, for another finishing a sentence on the phone without a pause.

2. Breathing pattern and observation

Your breathing is observed in sitting and lying. We look at:

• Whether the breath is taken from the upper chest or the abdominal region
• Whether the diaphragm is being used effectively
• Whether accessory muscles around the neck and shoulders are active even at rest
• Respiratory rate, rhythm and the ratio between inhalation and exhalation
• The amount and symmetry of chest expansion
• Posture, shoulder position and trunk alignment and their effect on breathing
• Cough strength, effectiveness and the ability to clear secretions

3. Measurement and functional testing

Objective measurements are used where appropriate, so progress rests on comparable numbers rather than on the phrase “I feel better”:

• Respiratory muscle strength: mouth pressure measurement to assess inspiratory and expiratory muscle strength.
• Breathlessness and fatigue scales: recording perceived exertion on standard scales.
• Functional capacity tests: sit-to-stand and walking-based tests that can be carried out in the clinic.
• Pulse and oxygen saturation: monitored with a pulse oximeter before, during and after exertion.
• Chest circumference: tape measurement of the difference in chest expansion on deep breathing.

Which tests are used depends on your age, diagnosis, current capacity and any restrictions set by your doctor. A test judged unsuitable is not carried out.

4. Programme plan and follow-up

The results are discussed with you. I explain what each finding means, which area we will work on and why a particular technique was chosen — because in my experience the person who understands what they are doing sustains the programme far more reliably.

A written home programme follows: which exercise, how many repetitions, how many times a day and at what intensity. Measurements are repeated at intervals and the programme is updated on that data. Where needed, written feedback is sent to your doctor.

No promise is made about duration or outcome. The pace of progress depends on the underlying picture, other conditions, age and — most of all — how regularly the programme is kept up at home.

Frequently Asked Questions