Airway clearance therapy in acute paediatric respiratory illness: A state-of-the-art review

Abstract

Background Despite unclear evidence of effectiveness or safety, airway clearance therapy (ACT) is frequently performed in infants and children with acute pulmonary disease. Objectives The aim of this review was to critically synthesise published evidence, expert opinion and pathophysiological principles to describe the indications, effects, precautions and application of commonly used ACT modalities for managing infants and children with acute pulmonary disease. Method A comprehensive narrative review of published literature was conducted. Articles describing paediatric populations were prioritised, but adult and animal studies were also considered where appropriate. Results There is a dearth of high-level evidence supporting the use of ACT in acutely ill infants and children. Conversely, studies have highlighted the lack of effect of different modalities for a variety of conditions, and in some cases serious associated complications have been reported. Airway clearance therapy may be considered when there is retention of pulmonary secretions, and the consequential airway obstruction impacts either acutely on respiratory mechanics and gaseous exchange and/or has the potential for long-term adverse sequelae [a condition that is the consequence of a previous disease or injury]. However, it should not be considered a routine intervention. Conclusion Airway clearance therapy should not be performed routinely in children admitted to hospital with acute respiratory conditions. Patients should be clinically assessed and treatment planned according to individual presentation, in those with signs and symptoms that are potentially amenable to ACT. Clinical implications This review can serve as a guide for physiotherapists in the respiratory management of children with acute respiratory illness, as well as identifying areas for clinical research.

Improving lung health in low-income and middle-income countries: from challenges to solutions

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The role of physiotherapy in the respiratory management of children with neuromuscular diseases: A South African perspective

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Inspiratory muscle training in children and adolescents living with neuromuscular diseases: A pre-experimental study

“…Furthermore, the variation in home programme adherence including the performance of stretches, passive movements and breathing exercises on a regular basis, could be confounding factors, which might influence the outcomes of upper limb and pulmonary function. The possible cognitive involvement commonly observed in children with dystrophinopathies such as DMD (Guglieri & Bushby 2011 ; Morrow et al 2019 ) could influence the outcome of IMT and should be considered in future research. Furthermore, longer-term studies (> 6 weeks of IMT) might be necessary to determine if IMT can slow down the regression of pulmonary function and respiratory muscle strength in children with NMD (Winkler et al 2000 ).…”