Chest physiotherapy is not useful in bronchiolitis.
Date First Published:
May 15, 2008
Last Updated:
September 19, 2008
Report by:
Jayachandran Panickar, Consultant Respiratory Paediatrician (Central Manchester & Manchester Children's University Hospital and Luton and Dunstable Hospital NHS Foundation Trust)
Search checked by:
Michael Eisenhut, Central Manchester & Manchester Children's University Hospital and Luton and Dunstable Hospital NHS Foundation Trust
Three-Part Question:
In [infants with bronchiolitis] does [physiotherapy] reduce [duration of illness, clinical severity or length of hospital stay]
Clinical Scenario:
A 6 month old baby is admitted to hospital with a 4 day history of coryzal symptoms, increasing cough, wheeze and decreased feeding. Respiratory syncytial virus was detected in nasopharyngeal secretions. She is needing oxygen and is on nasogastric feed. You wonder whether starting physiotherapy will improve her clinical condition.
Search Strategy:
Medline 1902-2008. Embase 1980-2008. Cochrane database (database of systematic reviews and cochrane central register of controlled trials.)
Search Details:
Medline: (bronchiolitis or RSV bronchiolitis) AND (physiotherapy or chest physiotherapy) LIMIT to humans. Embase: (bronchiolitis or RSV bronchiolitis) AND (physiotherapy or chest physiotherapy) LIMIT to humans. Cochrane Library: bronchiolitis AND physiotherapy.
Outcome:
Medline: 8 hits, Embase: 27 hits, Cochrane database: 2 hits. A total of 3 clinical trials were found. The rest were irrelevant.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Chest physiotherapy in acute bronchiolitis. Webb MSC, Martin JA, Cartlidge PHT, Ng YK, Wright NA. 1985 UK | 90 patients Physiotherapy (n=44) vs control (n=46) | Clinical trial. | Clinical score | No significant difference. | Relevant baseline characteristics not documented. Statistical power of study results unknown. |
| Duration of hospital stay | No significant difference. | ||||
| Length of acute illness | No significant difference. | ||||
| An evaluation of chest physiotherapy in the management of acute bronchiolitis: changing clinical practice Nicholas KJ, Dhouieb MO, Marshall TG, et al. 1999 UK | 50 Patients. Physiotherapy (n = 26) Clinical trail versus control (n = 24) | Clinical trail | Small study | ||
| Indications of conventional chest physiotherapy in acute bronchiolitis. Bohe L, Ferrero ME, Cuestas E, Polliotto L, Genoff M. 2004 Argentina | 32 patients Physiotherapy (n=16) vs control (n=16) | Clinical trial | Clinical score | No significant difference | Small study. |
| Duration of hospital stay | No significant difference |
Author Commentary:
Only 3 trials were identified. There were no significant differences in clinical score, duration of hospital stay and length of illness in the physiotherapy group compared to control group. In the study by Bohe et al. one child in the group receiving physiotherapy was with drawn after developing complications.
Bottom Line:
Current evidence does not support the use of physiotherapy in bronchiolitis.
References:
- Webb MSC, Martin JA, Cartlidge PHT, Ng YK, Wright NA.. Chest physiotherapy in acute bronchiolitis.
- Nicholas KJ, Dhouieb MO, Marshall TG, et al.. An evaluation of chest physiotherapy in the management of acute bronchiolitis: changing clinical practice
- Bohe L, Ferrero ME, Cuestas E, Polliotto L, Genoff M.. Indications of conventional chest physiotherapy in acute bronchiolitis.