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

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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.

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Acknowledgements

We would like to thank the physiotherapists not included in the study for their collaboration during the study period as well as the parents for allowing their children to be included in this work.

Conflicts of interests

None to declare.

Funding

This study was partly funded with a research grant from the Research and Development Fund of the Hôpitaux Universitaires de Genève.

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Correspondence to Isabelle Rochat.

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An erratum to this article can be found at http://dx.doi.org/10.1007/s00431-011-1601-8.

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Fig. 1
figure1

Clinical stabilisation according to the respiratory score (a) and the clinical score (b). The number of days until clinical stabilisation at admission was analysed in 99 patients (100%) and expressed as a proportion. The respiratory score was classified as follows: 0–4, 9–12 and 13–19. The clinical score was classified as follows: 1, 2 and 3. The respiratory, respectively the clinical, scores and the number of days until clinical stabilisation were significantly correlated. (JPEG 96 kb)

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Rochat, I., Leis, P., Bouchardy, M. et al. Chest physiotherapy using passive expiratory techniques does not reduce bronchiolitis severity: a randomised controlled trial. Eur J Pediatr 171, 457–462 (2012). https://doi.org/10.1007/s00431-011-1562-y

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Keywords

  • Bronchiolitis
  • Chest physiotherapy
  • Passive expiratory flux
  • Clinical stability