Chest physiotherapy using passive expiratory techniques does not reduce bronchiolitis severity: a randomised controlled trial

Abstract

Chest physiotherapy (CP) using passive expiratory manoeuvres is widely used in Western Europe for the treatment of bronchiolitis, despite lacking evidence for its efficacy. We undertook an open randomised trial to evaluate the effectiveness of CP in infants hospitalised for bronchiolitis by comparing the time to clinical stability, the daily improvement of a severity score and the occurrence of complications between patients with and without CP. Children <1 year admitted for bronchiolitis in a tertiary hospital during two consecutive respiratory syncytial virus seasons were randomised to group 1 with CP (prolonged slow expiratory technique, slow accelerated expiratory flow, rarely induced cough) or group 2 without CP. All children received standard care (rhinopharyngeal suctioning, minimal handling, oxygen for saturation ≥92%, fractionated meals). Ninety-nine eligible children (mean age, 3.9 months), 50 in group 1 and 49 in group 2, with similar baseline variables and clinical severity at admission. Time to clinical stability, assessed as primary outcome, was similar for both groups (2.9 ± 2.1 vs. 3.2 ± 2.8 days, P = 0.45). The rate of improvement of a clinical and respiratory score, defined as secondary outcome, only showed a slightly faster improvement of the respiratory score in the intervention group when including stethoacoustic properties (P = 0.044). Complications were rare but occurred more frequently, although not significantly (P = 0.21), in the control arm. In conclusion, this study shows the absence of effectiveness of CP using passive expiratory techniques in infants hospitalised for bronchiolitis. It seems justified to recommend against the routine use of CP in these patients.

Chest Physical Therapy in Acute Viral Bronchiolitis: An Updated Review

“…53 Yet in this study there was a lack of stratification of the initial clinical severity score, and CPT was not preceded by hypertonic saline nebulization. Nevertheless, the authors noted a significant decrease of the respiratory score.…”

“…CPT may delay or prevent the need for mechanical ventilation and may result in fewer complications, but the study was unable to demonstrate such outcomes, as the study did not have sufficient power. Also, the Gajdos et al study 41 and the Rochat et al study 53 have identified patient subgroups whose auscultation was improved by this treatment. This improvement would be due to the absence of atopic background.…”

Clinical Practice Guideline: The Diagnosis, Management, and Prevention of Bronchiolitis

“…[145][146][147][148] Since that review, a study 149 of the passive expiratory technique found a small, but significant reduction in duration of oxygen therapy, but no other benefits.…”

Nursing Care of Infants and Children with Bronchiolitis

“…2 It is not currently recommended as it is not superior to saline, therefore, should not be given. 2,9,12,20,38,39 Chest Physiotherapy (CPT)…”