A new role for physiotherapists at Lakeridge Health

Physiotherapists at Lakeridge Health are taking on new responsibilities that will give them a lot to…well, puff about.

“I don’t know of any other hospital in Canada that is doing this,” says Lindsay Graham, a physiotherapist in the Medicine Program at Lakeridge Health Oshawa.

Changes were made to the Physiotherapy Act in 2011 allowing physiotherapists (PTs) to maximize their roles in hospitals. While many hospitals have PTs now administering oxygen to patients directly, Lakeridge Health has taken the added step of helping educate and support their PTs to also administer inhaled medications (puffers).

“We want everyone to feel empowered and supported to work to their full scope of practice,” says Cathy Pierce, Interdisciplinary Specialist. “It’s really a testament to the level of expertise we have in our PTs here that they’ve taken the initiative.”


For Patricia James, a puff of Ventolin before her physiotherapy is making all the difference in her recovery. Patricia was admitted with pneumonia and underlying Chronic Obstructive Pulmonary Disease (COPD).

“I’m able to walk better and I don’t feel so tired afterwards,” she says.

PTs can also help educate patients like Patricia, who have never used puffers before, how to use them properly. This also helps them better manage their breathing issues at home after they leave the hospital.

“Research shows us people with COPD have one of the highest rates for readmission to hospital,” explains Lindsay. “But we also know that if someone is taught to use their inhaled medications properly, they have less COPD exacerbations and less trips back to the ER. This takes lots of education and lots of reinforcement.”


Recognizing this, Lakeridge Health is implementing a new case pathway for patients with COPD, a key component of which includes a referral to a PT for treatment and education. Working closely with nurses, respiratory therapists and pharmacists, PTs help reinforce messages around education and can really help patients to see how they can better manage their COPD and medications with everyday activities like walking.

“When someone comes to the ER with a COPD exacerbation, it’s the respiratory therapist doing the initial puffers. Usually, it’s a time of great distress for the patient and they might not be in the right frame of mind to learn,” adds Lindsay.

While doing chest physiotherapy and treatments that focus on functional mobility, PTs have the perfect opportunity to watch a patient take their puffer and give feedback. They can also focus on the proper use of spacers and why it’s key to use them with puffers, as well as educating about smoking cessation and flu vaccination.

“I’ve had one patient tell me they had been on puffers for 10 years and didn’t know they weren’t doing it properly,” says Lindsay. “If the medicine isn’t getting into their lungs, it’s not going to help them.”

As part of the new case pathway, patients with COPD are given two booklets called “Circle of Care”. Inside are detailed instructions and photos on how to use the various puffers available, how to prevent an exacerbation and what to do if you need to come to the ER.

The goal is that within three to four days, every COPD patient with non-complex needs will return home well again and with the skills and knowledge they need to effectively manage their own care.

“We’re all working as a team – pharmacy, respiratory therapy, nursing and physiotherapy  – so we have better patient outcomes with COPD,” adds Lindsay.

Did you know?

Approximately 780,000 Ontarians are living with COPD, which includes two major lung diseases –emphysema and chronic bronchitis – and is primarily caused by smoking, according to the Lung Association of Ontario.

For people with COPD, flare-ups or exacerbations can be brought on by a cold or flu, or by something as simple as a change in weather or poor air quality. These flare-ups can result in emergency room visits, hospitalizations and in some cases, death.

At Lakeridge Health, PTs now administer and help educate about the following inhaled medications:

  • Salbutamol (Ventolin)
  • Ipratropium (Atrovent)
  • Ciclesonide (Alvesco)
  • Salmeterol/Fluticasone (Advair) (MDI)
  • Tiotropium (Spiriva)
  • Formoterol/Budesonide (Symbicort)
  • Salmeterol/Fluticasone (Advair) (Diskus)