Standard bearer: Profiling the deputy director of rehabilitation and therapies at the Royal Brompton and Harefield NHS Foundation Trust

Despite living in Gloucestershire, physio Penny Agent commutes to London five days a week, where she works for Royal Brompton and Harefield NHS Foundation Trust.

She is the deputy director of rehabilitation and therapies for the trust and a professional lead for physiotherapy.

Her directorate has about 100 staff members and includes an adult cystic fibrosis team.

Based at the Royal Brompton Hospital in west London, the multidisciplinary team includes nurses, dieticians and six specialist physiotherapists.

‘I manage therapy services across the trust, but I’ve always maintained a particular clinical interest in cystic fibrosis,’ says Mrs Agent.

The hospital hosts the largest cystic fibrosis centre in Europe, caring for about 650 adults.

As a result Mrs Agent is keenly aware of clinical developments in the field and encourages the centre to try new things. With her backing the team has pioneered the use of innovative treatment options for cystic fibrosis, in particular with regards to inhalation therapy.

‘I always set myself and my staff high standards and strive to deliver the best service possible,’ says Mrs Agent.

‘That means staying at the forefront of developments and working to deliver the best and most up to date clinical care.’

Thanks to this progressive stance, the Royal Brompton was one of the first cystic fibrosis centres in the UK to make a dry powder inhalator, known as the TOBI Podhaler, available to patients.

Mrs Agent explains that inhaled drugs are commonly used in cystic fibrosis because they reach the airways swiftly. They were traditionally delivered through nebulisers, which produce a fine mist of droplets.

However, administering medicine using a dry powder inhalator has certain advantages.

The breath activated, hand-held device works by delivering a dry powder dose of the antibiotic tobramycin sodium.

This drug helps to inhibit the growth of a harmful bacterium which can cause lung infections among patients with cystic fibrosis.

‘Nebulisers are commonplace in cystic fibrosis but they take a relatively long time to use, and need lots of cleaning – and patients don’t tend to be great at that,’ says Mrs Agent.

Introducing the dry powder inhalator at the centre brought numerous benefit for both patients and staff, she notes.

Specialist physiotherapists in the team provide patients with airway clearance programmes, musculoskeletal care and exercise advice.

They also provide instructions on how to use equipment, such as nebulisers and the TOBI Podhaler.

Previously, most patients requiring long-term antibiotics could only take them in a nebulised form.

This required lots of equipment, a longer set up and inhalation time, and regular cleaning and drying of the nebulisers after each use. Additionally, many of the medications required refrigeration.

In comparison the new technology is quick and simple, both to explain and to use. It also requires minimal cleaning and is proving to be as effective as the nebulised form of antibiotic.

As well as embracing new treatments, Mrs Agent has also acted as a clinical expert for the National Institute for Health and Clinical Excellence (NICE).  In that role, Mrs Agent helped to develop guidance for new cystic fibrosis treatments.

In 2012 she was invited to comment on Mannitol, a drug that augments airway clearance, after she was involved in clinical research into the treatment.

The four-month process required her to study draft proposals and attend a formal meeting to answer questions from members of the NICE panel.

‘I would really recommend other physios to get involved as clinical experts, because it allows you to see the bigger picture and learn how guidelines are produced,’ says Mrs Agent. fl

For further information about the Royal Brompton’s cystic fibrosis centre,

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