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6 AARC Times December 2008

Last year, the American Respiratory Care Foundation(ARCF) honored Sergio Zuffo, PT, with its prestigiousHéctor León Garza, MD, Award for Excellence in Interna-tional Respiratory Care for the work he’s done to raiseawareness of the need for respiratory specialization inItaly. In this interview, he shares his background in thisarea and explains what’s being done today to foster thedevelopment of respiratory physiotherapists in Italy.

AARC Times: When and how did you become interestedin physiotherapy, and what led you to specialize in therespiratory care aspects of the profession?Zuffo: I became interested in physiotherapy in 1973 whenI enrolled in the specific, three-year course at the Uni-versity of Florence. The training program includes somerespiratory physiotherapy, but back then the specificswere limited to postural drainage, percussion, and classicrespiratory exercises.

I started working as a physiotherapist in 1977, and in1983 I transferred to the Ospedale Pediatric Meyer in Flo-rence. Up to that point respiratory physiotherapy hadonly been lodged in a remote corner of my brain. In thebeginning I worked in other areas, and not just with res-piratory problems. But from then on it was a gradualcrescendo.

At the Meyer hospital there was — and still is — theRegional Center for Cystic Fibrosis. The CF patients andtheir problems led me to learn new airway clearancetechniques, and I got to work with the people who de-veloped them. I went to Merete Falk and Jens Andersen inDenmark for positive pressure — PEP mask and PCPAP.We had Jean Chevaillier and Guy Postiaux come from Bel-gium to teach us autogenic drainage and respiratoryphysiotherapy guided by auscultation, respectively. We

worked with English colleagues on activecycle of breathing techniques, etc.

In the meantime, other demands for res-piratory physiotherapy were emerging, suchas care for preterm babies receiving me-chanical ventilation in the NICU. So I wentto the Hospital de Port Royal in Paris whereRemi Remondière was working and teach-ing, and there I attended his course inneonatal respiratory physiotherapy at the

École des Cadres de Kinésitherapie “Bois-Larris.” Then Iwent to the PICU at Great Ormond Street Hospital forChildren in London where, in addition to focusing on se-vere respiratory problems, I had direct experience withan important patient-evaluation tool, the Problem Ori-ented Medical Record, which we introduced here in Italy.Increasing demands for help with many other respira-tory problems related to a wide range of diseases also re-quired further study in oxygen therapy, aerosol therapy,endotracheal aspiration, tracheostomy, invasive and non-invasive mechanical ventilation, physical exercise, andso on.

For several years now I have been working exclusivelywith pediatric respiratory problems, and I teach trainingcourses for physiotherapists, degree courses in physio-therapy, and master programs in respiratory physiother-apy and rehabilitation at the University of Milan and inpediatric physiotherapy at the University of Florence. Ibecame a respiratory physiotherapist through workingon children’s needs, refresher courses and updates, prac-tical experience, teaching experience, and by getting in-volved in respiratory issues in different branches ofmedicine.

AARC Times: Where are you working now, and what areyour primary responsibilities there? How is your rolesimilar to, or different from, that of a respiratory thera-pist here in the United States?Zuffo: I’m still working at the Ospedale Pediatrico Meyerin Florence, where I am the coordinator of the physio-therapy team for respiratory problems. As to the role, wehave to distinguish between what I do personally and thesituation in Italy on the whole. While in the United Statesthere has been for years a specific training program for

Paving the Way for a RespiratorySpecialty in Italy

Physiotherapist Sergio

Zuffo explains how he and

his colleagues are helping

to promote respiratory care

in their country — and how

the AARC is assisting them

in their goals.

8 AARC Tımes December 2008

On the Cover

the respiratory therapist as aspecialist in respiratory prob-lems distinct from the physicaltherapist, in Europe there is asingle training program, andonly a few countries offer apost-graduate specialization inrespiratory therapy or ICU ther-apy.

A survey conducted by ourassociation in Italy revealedproblems in training and roles:In respiratory matters the phys-iotherapist’s skills and respon-sibilities are still limited. Oftenit is the physician who conductsthe procedures for assessing thepatient in order to plan the ap-propriate rehabilitation pro-gram. There are still very fewphysiotherapists who work onthe most specialized tech-niques, such as withdrawalfrom mechanical or noninva-sive ventilation.

The specialization that began with the master’scourse that we recently established at the University ofMilan — currently in its second edition — aims at aug-menting the physiotherapist’s skills, leading the pro-fessional toward the possibility of being an expert inphysiotherapeutic treatment of respiratory diseases.This is accomplished by enhancing their knowledge ofthe various approaches (pulmonary rehabilitation, air-way clearance techniques, invasive and noninvasivemechanical ventilation, appropriate physical exercise,education), the functional evaluation of the cardiores-piratory apparatus, and organizing rehabilitation pro-grams. This should increase their skills and help thembecome coordinators of the respiratory physiotherapyteams, teachers of respiratory physiotherapy in re-fresher/update courses and/or degree courses for phys-iotherapists, and responsible for respiratory physio-therapy within the context of research protocols.

AARC Times: How did you get involved with the Italianrespiratory organization, ARIR (Associazione Riabilita-tori dell’Insufficienza Respiratoria), and what is yourcurrent role with the organization? What are the ARIR’stop goals and objectives?

Zuffo: I got involved withthe ARIR mainly because,ever since it was estab-lished, it has been the mostimportant and responsiveorganization in Italy pursu-ing cultural and organiza-tional improvement inrespiratory physiotherapyand rehabilitation. I amcurrently an executiveboard member, section edi-tor for neonatology of theARIR Review, member of theEditorial Board for “ARIR’sSelections from RESPIRATORY

CARE and AARC Times,” andteacher of various ARIRcourses and seminars. Lastbut not least, I representARIR to the AARC’s Interna-tional Council for Respira-tory Care™ (ICRC).

The main goal of theARIR is to extend the sci-

ence of respiratory care to other branches of medicalscience — chronic respiratory disease, intensive care,pediatrics, and so on. The association also promotesthe cultural growth and development of professionalrespiratory physiotherapists in the Italian health sys-tem. ARIR works hard to achieve its goals by:

• Disseminating information about respiratory phys- iotherapists and the importance of what we do in Italy

• Continuing education, training, and teaching• Publishing• Affiliations with other associations• Educational project• Communication.An important program made possible, thanks to the

invaluable cooperation of the AARC, is the publicationof a selection of articles in their original language andformat, the “ARIR’s Selections from RESPIRATORY CARE andAARC Times.” The aim of this selection is to bring themembers of ARIR closer to their colleagues in the AARCand to build a bridge between the American and Italianworlds of respiratory care.

“With its ongoing trainingprograms, its prestigious jour-nal, with its Clinical Practice

Guidelines, and with the inter-national support thanks to the

International Council, theAARC has contributed … to

the growth and developmentof respiratory care throughoutthe world… We believe that

all of this will help bring aboutlegal recognition of this pro-fession and an increase in the

number of real respiratoryphysiotherapists in Italy.”

– Sergio Zuffo, PT

10 AARC Tımes December 2008

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AARC Times: What are the latest developments in the mas-ter’s course at the University of Milan, and how will thislevel of training benefit health care in your country?Zuffo:The master’s program offers specialization after thefirst-level degree. It is now in the second edition, and thegoverning body of the University of Milan has approved athird. The participants come from all parts of Italy, whichwill certainly foster more uniform growth and develop-ment of respiratory care in Italy.

We are also planning to organize opportunities for dis-cussion and exchange among the colleagues who have al-ready completed the master’s program to compare thedifferent situations in Italy and to help them continue thegrowth process that is desirable for all health care profes-sionals. Furthermore, whenever possible, we try to en-courage and support those colleagues who havecompleted the master’s program to engage in teaching ac-tivities in the first-level degree course in order to improvethe “basic respiratory training” of physiotherapists which,for the time being, is very limited in Italy (3–5% of thecredit hours).

Our next goal is to include lessons in the second-leveldegree course that will provide physiotherapists with co-ordinating and management duties with the knowledgeand skills needed for better management of staff dedi-cated to the treatment and rehabilitation of patients withrespiratory diseases.

AARC Times: 2008 was designated the “Anno del Respiro” inItaly — the “Year of Respiration.” What activities havetaken place this year to mark the occasion, and how haveyou and your organization been involved in them?Zuffo:To mark the “Year of Respiration” we participated inall the programs planned by the FIMPST — FederazioneItaliana Contro le Malattie Polmonari Sociali e la Tuber-colosi (the Italian Federation for Social Pulmonary Dis-eases and Tuberculosis) — to sensitize the people to theincrease in chronic respiratory diseases. Furthermore, incooperation with Riabilitazione Oggi, an association ofphysiotherapists working in different areas of respiratorycare, with branches throughout the country, we helped toplan a series of information/training meetings to increasethe awareness of our colleagues concerning the increase inrespiratory diseases. The Third European Respiratory CareAssociation Congress, coming up April 2–4, 2009, fits per-fectly into this context as well.

AARC Times: You currently serve on the ICRC Board of Gov-ernors. How do you believe this international organizationis helping to promote an exchange of ideas among respi-ratory care professionals around the world?

Zuffo: Working with people who have health problems,and in our case mainly respiratory problems, is often de-manding, difficult, and tiring. But being able to talk to col-leagues who do the same job, who share your doubts, orwho have found new and useful treatment methods, helpsyou grow. This experience helps you understand how faryou can go and gives you the spark, or energy, to embarkon new paths. Cultural and professional exchanges alsohelp strengthen your feeling of purpose and the feeling ofdignity about what you do and the role you play.

As a result of all this, you face problems with a littlemore confidence — never with any mathematical cer-tainty of being right — but with more likelihood of makingfewer mistakes and getting ever closer to good practice,with the support, insofar as possible, of proof of effective-ness. Knowing what can and what cannot be achievedthrough our treatments makes it easier to enter into anhonest, open “contract” with our respiratory patients, andat the same time, it gives us a glimpse of broader horizons.

Working poorly, without awareness, or seeing thingsdone poorly makes us very uncomfortable. Work welldone, with respect to the patients and their families, is sat-isfying. It puts you at peace with yourself and the peoplearound you; it makes you feel “good” and fulfilled. With itsongoing training programs, its prestigious journal, with itsClinical Practice Guidelines, and with the internationalsupport thanks to the International Council, the AARC hascontributed, and is continuing to make a significant con-tribution, to the growth and development of respiratorycare throughout the world by stimulating us to keep onimproving. Furthermore, we believe that all of this willhelp bring about legal recognition of this profession andan increase in the number of real respiratory physiother-apists in Italy.

AARC Times: In 2007, you were named the third annual re-cipient of the ARCF’s Héctor León Garza, MD, Award for Ex-cellence in International Respiratory Care. How did it feelto receive this honor?Zuffo: At first I was stunned and felt that I didn’t deserveit, at least not personally. Then came a feeling of immensegratitude to the ICRC of the AARC, and last but not least, tomy association, the ARIR, of which I am merely a simplerepresentative. I interpreted the award as an acknowl-edgement and recognition of the entire association towhich all my colleagues make important — and voluntary— contributions. And our president, the dynamic MartaLazzeri, deserves special thanks. It was difficult for me toverbalize the feeling, so I wrote a letter to my ICRC col-leagues. I would like to repeat that letter in part for youhere:

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AARC Tımes December 2008 11

“Thank you to the AARC for the way you welcomedus from the very beginning some years ago: withwarmth, friendship, and respect. Before me, other col-leagues —Pamela, Giovanni, and Marta — participatedin the Congresses and meetings. I, myself, have at-tended only the last three AARC Congresses andmeetings. But from the first I noticed, and was grate-ful for, the care and attention you all gave me. Thankyou Jerome Sullivan, Hassan Alorainy, John Hiser, andeverybody.

“To quote Sam Giordano’s presentation of theARIR’s publishing project, ‘Selections from RESPIRATORY

CARE and AARC Times’: ‘Even though the American As-

sociation for Respiratory Care is comprised primarilyof respiratory therapists, we recognize and respect themany other health care professionals around theworld such as physiotherapists, etc….’

“And again, still Sam’s words, ‘While we all recog-nize that throughout the world we may be separatedby distance, culture, and language, we also recognizethat respiratory patients deserve the best care possi-ble. Toward that end, we are delighted to collaboratewith other organizations such as ARIR in order to pro-vide increased access to information regarding thetreatment of these patients….’” ■