Abstract
1. Changes in lung function in emphysema have shown that in early disease there is a marked increase in Residual and Functional Residual Capacities, whereas these change little with increasing disease, which is measured better by falling Vital Capacity and Maximum Breathing Capacity.
2. Twenty-two patients with pulmonary emphysema have been examined before and after a course of breathing exercises. Most of them claimed subjective improvement. Five showed improvement in lung function tests not explainable by ordinary fluctuations in comparable patients. Most of the others showed only slight improvement in Vital Capacity and Maximum Breathing Capacity and negligible change in tests of Residual and Total Capacities, of Intrapulmonary Mixing Efficiency, or of arterial oxygen content. Nevertheless, their Maximum Diaphragm Excursion was seen, on chest screening, to improve considerably.
3. In nine further patients with emphysema, it was found that the apparent increase in Diaphragm Excursion after treatment resulted from a decrease in vertical chest movement, which originally hid the real diaphragm movement. Corrected Diaphragm Excursion was normal in comparison with the diminished Vital Capacities. There was no true increase in diaphragm movement after physiotherapy.
4. It may be concluded that the consistent benefits of physiotherapy are partly psychological and partly physical, in reducing inefficient spinal and should.er movement. The treatment gives physiological benefits to a few patients only. Nevertheless, these benefits are enough to justify the treatment, for there can be little doubt that a course of breathing exercises from a competent physiotherapist will usually leave the patient feeling sufficiently improved to satisfy both himself and his teacher that the time involved has been worthwhile.