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

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An Erratum to this article was published on 21 October 2011

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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References

  1. Bailleux SLD (2008) La bronchiolite du nourrisson—La kinésithérapie respiratoire par augmentation du flux expiratoire: une évidence? KS 484:5–17

    Google Scholar 

  2. Bohe L, Ferrero ME, Cuestas E, Polliotto L, Genoff M (2004) Indications of conventional chest physiotherapy in acute bronchiolitis. Medicina (B Aires) 64(3):198–200

    Google Scholar 

  3. Bronchiolite: pas de kinésithérapie respiratoire systématique (2006). Synthèse élaborée collectivement par la Rédaction Rev Prescrire 26 (277):768–770

  4. Bronchiolitis SoDaMo (2006) Diagnosis and management of bronchiolitis. Pediatrics 118(4):1774–1793

    Article  Google Scholar 

  5. Chalumeau M, Foix-L’Helias L, Scheinmann P, Zuani P, Gendrel D, Ducou-le-Pointe H (2002) Rib fractures after chest physiotherapy for bronchiolitis or pneumonia in infants. Pediatr Radiol 32(9):644–647

    Article  PubMed  Google Scholar 

  6. Chaneliere C, Moreux N, Pracros JP, Bellon G, Reix P (2006) Rib fractures after chest physiotherapy: a report of 2 cases. Arch Pediatr 13(11):1410–1412

    Article  PubMed  CAS  Google Scholar 

  7. Fausser CPD, Evenou D (2004) Fiche d’observation et de transmission kinésithérapique ARB 2003 2004: son utilisation en pratique libérale dans la bronchiolite. Kinésithérapeute scientifique 441:27–36

    Google Scholar 

  8. Fouré H (2007) Arguments pour une kinésithérapie de désencombrement guidée par la courbe débit/volume. Kinesthiter Rev 70:46–51

    Google Scholar 

  9. Gajdos V, Beydon N, Bommenel L, Pellegrino B, de Pontual L, Bailleux S, Labrune P, Bouyer J (2009) Inter-observer agreement between physicians, nurses, and respiratory therapists for respiratory clinical evaluation in bronchiolitis. Pediatr Pulmonol 44(8):754–762

    Article  PubMed  CAS  Google Scholar 

  10. Gajdos V, Katsahian S, Beydon N, Abadie V, de Pontual L, Larrar S, Epaud R, Chevallier B, Bailleux S, Mollet-Boudjemline A, Bouyer J, Chevret S, Labrune P (2010) Effectiveness of chest physiotherapy in infants hospitalized with acute bronchiolitis: a multicenter, randomized, controlled trial. PLoS Med 7(9)

  11. Giebels K, Marcotte JE, Podoba J, Rousseau C, Denis MH, Fauvel V, Laberge S (2008) Prophylaxis against respiratory syncytial virus in young children with cystic fibrosis. Pediatr Pulmonol 43(2):169–174

    Article  PubMed  Google Scholar 

  12. Houtmeyers E, Gosselink R, Gayan-Ramirez G, Decramer M (1999) Regulation of mucociliary clearance in health and disease. Eur Respir J 13(5):1177–1188

    Article  PubMed  CAS  Google Scholar 

  13. Joud P (2000) Le score d’encombrement des voies aériennes (SEVA): un outil indispensable pour le praticien dans le suivi clinique du désencombrement chez le nourrisson. Kinésithérapeute scientifique 396:21–26

    Google Scholar 

  14. Mitchell I, Tough S, Gillis L, Majaesic C (2006) Beyond randomized controlled trials: a “real life” experience of respiratory syncytial virus infection prevention in infancy with and without palivizumab. Pediatr Pulmonol 41(12):1167–1174

    Article  PubMed  Google Scholar 

  15. Nelson R (2003) Bronchiolitis drugs lack convincing evidence of efficacy. Lancet 361(9361):939

    Article  PubMed  Google Scholar 

  16. Nicholas KJDM, Marshall TG, Edmunds AT, Grant MB (1999) An evaluation of chest physiotherapy in the management of acute bronchiolitis. Physiotherapy 85(12):669–673

    Article  Google Scholar 

  17. Oberwaldner B (2000) Physiotherapy for airway clearance in paediatrics. Eur Respir J 15(1):196–204

    Article  PubMed  CAS  Google Scholar 

  18. Patel H, Platt R, Lozano JM, Wang EE (2004) Glucocorticoids for acute viral bronchiolitis in infants and young children. Cochrane Database Syst Rev 3:CD004878

    PubMed  Google Scholar 

  19. Perrotta C, Ortiz Z, Roque M (2007) Chest physiotherapy for acute bronchiolitis in paediatric patients between 0 and 24 months old. Cochrane Database Syst Rev 1:CD004873

    PubMed  Google Scholar 

  20. Postiaux G (2001) [Bronchiolitis in infants. What are the techniques of bronchial and upper airway respiratory therapy adapted to infants?]. Arch Pediatr 8(Suppl 1):117S–125S

    Article  PubMed  Google Scholar 

  21. Postiaux GDR, Marchand E, Demay M, Jacquy J, Mangiaracina M (2004) Chest physiotherapy in infant bronchiolitis—a new approach (abstract). In: VIth International Congress on Pediatric Pulmonology, Lisboa

  22. Simoes EA (1999) Respiratory syncytial virus infection. Lancet 354(9181):847–852

    Article  PubMed  CAS  Google Scholar 

  23. Smyth RL, Openshaw PJ (2006) Bronchiolitis. Lancet 368(9532):312–322

    Article  PubMed  Google Scholar 

  24. Stagnara J, Balagny E, Cossalter B, Dommerges JP, Dournel C, Drahi E, Gauchez H, Guillot F, Javault D, Lagardere B, Le Masne A, Lesprit E, Maidenberg M, Maufroy D, Picherot G, Renaud H, Robert J, Undreiner F (2001) [Management of bronchiolitis in the infant. Recommendations. Long text]. Arch Pediatr 8(Suppl 1):11S–23S

    Article  PubMed  Google Scholar 

  25. Traitement de la bronchiolite aiguë du nourrisson. Recommandations du groupe de travail de pneumologie pédiatrique (SAPP) (2003). Paediatrica 14 (6):22–25

    Google Scholar 

  26. van Woensel JB, van Aalderen WM (2002) Treatment for bronchiolitis: the story continues. Lancet 360(9327):101–102

    Article  PubMed  Google Scholar 

  27. Wang EE, Milner RA, Navas L, Maj H (1992) Observer agreement for respiratory signs and oximetry in infants hospitalized with lower respiratory infections. Am Rev Respir Dis 145(1):106–109

    Article  PubMed  CAS  Google Scholar 

  28. Webb MS, Martin JA, Cartlidge PH, Ng YK, Wright NA (1985) Chest physiotherapy in acute bronchiolitis. Arch Dis Child 60(11):1078–1079

    Article  PubMed  CAS  Google Scholar 

  29. Willson DF, Landrigan CP, Horn SD, Smout RJ (2003) Complications in infants hospitalized for bronchiolitis or respiratory syncytial virus pneumonia. J Pediatr 143(5 Suppl):S142–S149

    PubMed  Google Scholar 

Download references

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.

Author information

Authors and Affiliations

  1. Pediatric Pulmonology Unit, Children’s Hospital, University Hospitals, Geneva, Switzerland

    Isabelle Rochat & Constance Barazzone Argiroffo

  2. Pediatric Physiotherapy, Children’s Hospital, University Hospitals, Geneva, Switzerland

    Patricia Leis, Marie Bouchardy, Christine Oberli, Hendrika Sourial & Margrit Friedli-Burri

  3. Division of Clinical Epidemiology, University Hospitals, Geneva, Switzerland

    Thomas Perneger

  4. Pediatric Pulmonology Unit, CHUV, Rue du Bugnon 46, 1011, Lausanne, Switzerland

    Isabelle Rochat

Authors
  1. Isabelle Rochat
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  2. Patricia Leis
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  4. Christine Oberli
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  8. Constance Barazzone Argiroffo
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Correspondence to Isabelle Rochat.

Additional information

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

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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  • DOI: https://doi.org/10.1007/s00431-011-1562-y

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