By Simone Gambazza, PT & Sergio Zuffo, PT

ARIR, Associazione Italiana Riabilitatori dell’Insufficienza Respiratoria (Italian Association for the Rehabilitation of Respiratory Care) was born in 1989 from an idea of a few physiotherapists (PT), who felt the need to extend the practice of physiotherapy beyond the treatment of orthopedic and neurologic disorders. This desire paved the way for some Italian physiotherapists to broaden their practice to include respiratory care and pulmonary rehabilitation. A number ofchest physiotherapists followed a model imported in the 1970’s from the Brompton Hospital, and began to differentiate their professional practice to include the treatment of subjects suffering from cystic fibrosis and from complications of thoracic surgery.

Post-graduate Respiratory PT students enrolled in the program developed by ARIR and the University of Milan.

Due to the lack of a formal educational program in pulmonary rehabilitation and the less than adequate role attributed to the physiotherapist by the National Health Care System, ARIR faced a tremendous challenge to gain recognition for the establishment of the respiratory physiotherapist professional. In 1994, after a five year effort by the Association, the Ministry of Health ratified the professional role and profile of Physiotherapists, giving them the chance to access post-graduate respiratory care courses following their 3-year PT degree. Thirteen years later, ARIR sealed an alliance with the University of Milan, officially recognizing the professional of physiotherapist in the respiratory field, which provided post-graduate academic training in respiratory physiotherapy and pulmonary rehabilitation. In the same year of 2007, the program at the University of Milan became the first post-graduate program in Respiratory Care recognized by the International Education Recognition System (IERS) and maintains its Level III approval status to this date. Many Italian physiotherapists have decided to specialize in respiratory physiotherapy and rehabilitation, contributing to the cultural growth and development of respiratory physiotherapists in the Italian health care system. Today, ARIR is one of the partners of the European Respiratory Society in developing a core syllabus for post-graduate training in respiratory physiotherapy.

50 year old male patient with severe dyspnea on NIV is supervised by a Respiratory PT while performing endurance training.

Respiratory physiotherapists in Italy often work on a multidisciplinary team in respiratory wards, outpatient clinics, home, intensive care units, and palliative care services. The Respiratory PT typically starts with a comprehensive assessment of the patient’s respiratory function, including respiratory signs, degree of dyspnea, oxygenation, cough characteristics and questions about activity of everyday life. Assessment of postural and musculoskeletal function together with exercise capacity is fundamental as these form a common barrier to normal functioning in many respiratory diseases. Because their contact with patients and their families is often frequent and relatively long, they are ideally positioned to deliver appropriate information and advice to improve overall treatment and adherence to the medical regime. The Respiratory PT’s knowledge and understanding of chronic disease management, from inhalation therapy to healthy behaviors, is an important aspect which further contributes to the patient’s well-being. Although the most requested intervention is to clear secretions, the Respiratory PT is called upon to address many other problems, such as supporting weaning from mechanical ventilation, managing tracheostomy, optimizing oxygen delivery, setting up non-invasive mechanical ventilation and early mobilization of the patient.

ARIR is a founding member of the 29-country International Council for Respiratory Care (ICRC) representing Italy on this body since 1989. From the onset of its creation, ARIR has been dedicated to covering scientific updates, publishing and disseminating information about respiratory physiotherapy all over the country. The 3rd International ARIR Conference on Respiratory Physiotherapy embodies their educational mission and is entitled “Physiotherapy, Rehabilitation and the Burden of Respiratory Diseases”. All are invited to participate in this international conference which will gather March 10-12, 2016 in Rimini, Italy. National and international experts will present on non-invasive ventilation, exercise therapy, adherence, airway clearance, sleep disorders and cardiac-rehabilitation. The conference represents another challenge for ARIR and for all Italian respiratory physiotherapists, trying to make the respiratory care world smaller and better for our patients.