Ahpra registration PHY0002298174
How these guides are written and reviewed →
This section is a quick-reference guide to the main medicines used in heart and lung care, written mainly for physiotherapists and allied health professionals.1,2,3 It groups drugs by what they do, and — crucially for physiotherapy — flags how each affects the timing and safety of an airway-clearance or exercise session. Choose a category below, or read the shared timing principles here first.
The medication categories
The tables below summarise the principal pharmacological agents used in cardiorespiratory practice, with a focus on what the physiotherapist needs to know to recognise treatment failure, time interventions appropriately, counsel patients, and identify potential adverse effects during a session. They are reference summaries — local prescribing decisions and individual patient management remain with the treating medical team and current editions of Therapeutic Guidelines.
All doses are typical adult doses for representative indications and require adjustment for renal function, weight, age, drug interactions, and patient-specific factors.4,5
Timing physiotherapy around key medicines
Medicines shape what is safe and effective in a session. The principles below apply across the drug classes in the tables; the right-hand Implications for physiotherapy column flags drug-specific points.
Time the session around key medicines
| Medicine | Timing relative to physiotherapy |
|---|---|
| Short-acting bronchodilator (salbutamol / ipratropium) | Give 10–15 min before airway clearance or exercise to open the airways and reduce bronchospasm. |
| Nebulised hypertonic saline / mucolytics | Perform airway clearance during or immediately after — viscosity reduction is at its peak. |
| Inhaled antibiotics (tobramycin, colistin, aztreonam) | Clear the airways first, then give the inhaled antibiotic to maximise deposition; pre-treat with a bronchodilator, as these can cause bronchospasm. |
| Analgesia (including opioids, post-operative) | Time clearance and mobilisation to the peak analgesic effect in pain-limited patients — but check sedation and respiratory rate first. |
| Diuretics | Avoid demanding sessions at the diuretic peak (urinary urgency, transient postural blood-pressure drop). |
Adverse effects that can affect a session
- Beta-agonists — tachycardia and tremor; can blunt heart rate as an exercise marker.
- Systemic corticosteroids — proximal (steroid) myopathy, hyperglycaemia, mood change, skin fragility and osteoporosis/fracture risk; modify resistance loads and avoid heavy manual techniques in long-term users.
- Fluoroquinolones (ciprofloxacin, moxifloxacin) — tendinopathy and rupture risk (especially the Achilles, in older patients and those also on steroids); be cautious with loaded exercise and ask patients to report tendon pain.
- Beta-blockers — blunt the heart-rate response; gauge intensity with rating of perceived exertion (RPE), not heart rate.
- Anticoagulants / antiplatelets — bruising and bleeding risk; use caution with vigorous percussion, vibration and deep manual work.
- Opioids and sedatives — drowsiness, respiratory depression and falls risk; confirm alertness before mobilising.
- Aminoglycosides (gentamicin, tobramycin) — vestibular toxicity and ototoxicity that can affect balance and gait.
- Inhaled agents — bronchospasm, cough and voice change; keep a bronchodilator available.
When to withhold or delay physiotherapy
- Acute, uncontrolled bronchospasm — treat with a bronchodilator and settle before clearance or exercise.
- Haemodynamic instability, a new uncontrolled arrhythmia, or chest pain.
- The patient is febrile, septic or acutely deteriorating — liaise with the treating team first.
- Platelets <20 × 10⁹/L — avoid percussion, vibration and high-resistance work; gentle mobilisation only.
- Significant haemoptysis — avoid percussion, vibration and PEP devices.
- Oxygen saturation falling below target despite supplemental oxygen, or new severe breathlessness.
- A just-given inhaled antibiotic or nebuliser is causing bronchospasm — pause and reassess.
References & evidence base
- Global Initiative for Asthma. Global strategy for asthma management and prevention: 2026 update. GINA; 2026. Available at: ginasthma.org
- Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management and prevention of COPD: 2026 report. GOLD; 2026. Available at: goldcopd.org
- McDonagh TA, Metra M, Adamo M, et al. 2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2021;42(36):3599–3726.
- Australian Medicines Handbook. Adelaide: Australian Medicines Handbook Pty Ltd, 2026.
- Cazzola M, Page CP, Calzetta L, Matera MG. Pharmacology and therapeutics of bronchodilators. Pharmacol Rev 2012;64(3):450–504.
References are numbered in citation order (Vancouver/BMJ style) and were current at the time of writing. Guidelines are living documents — verify against the latest version before clinical use. For drug-specific detail, including full product information, consult MedsInfo.
Corrections: If something on this page is wrong, out of date or unclear, we want to know. Email reception@inspireclinic.au with the page name and what you believe is incorrect. Substantive corrections are made promptly, and the guide’s version and last-updated date are changed to reflect it.