Do not use chest physiotherapy (CPT) in bronchiolitis, it is not helpful

Do not use chest physiotherapy (CPT) in bronchiolitis, it is not helpful: Excerpt from Avoiding Common Pediatric Errors

Author: Madan Dharmar, MD

What to Do - Make a Decision

CPT in pediatric respiratory diseases has been used to assist in the clearance of tracheobronchial secretions. The main goal is to clear the airway obstruction, open collapsed airways, reduce airway resistance, enhance gas exchange, and reduce the work of breathing. CPT can play a role in improving a patient's respiratory status and expedite recovery. CPT in pediatric patients involves various techniques such as chest percussion, vibration in postural drainage positions, chest shaking, directed coughing, and slow passive forced exhalation. CPT is useful for individuals with copious mucus or thick secretions, and those with weak respiratory mechanics or those with ineffective cough. In some situations, CPT could be harmful by causing an increase in bronchospasm, inducing pulmonary hypertension, repositioning a foreign body, or destabilizing a sick infant. CPT has been linked to adverse events such as injury (rib fracture) and long term neurologic complication. But a review of the literature shows insufficient evidence of adverse events following chest physiotherapy.

Use of Chest Physiotherapy Cystic Fibrosis (CF) and Bronchiectasis. Removal of bronchopulmonary secretions is an integral part of the management of CF. CPT helps to remove excessive secretions, thereby improving ventilation in the short term. In patients with CF, there is evidence that CPT causes a significantly greater amount of sputum expectoration when compared to no treatment.

Primary Pneumonia With Consolidation. Duringthe treatmentof pneumonia with consolidation, CPT is found to have a beneficial effect in mobilizing and clearing secretion from the lung, especially in weakened children and children unable to participate in pulmonary exercises and deep breathing. In patients withconsolidation, CPT helps inthe repositioningof thepatient for optimal ventilation and perfusion even though it may not have other direct clinical beneficial effects.

Acute Atelectasis. Acute lobar atelectasis is more commonly encountered in the intensive care unit (ICU) due to excess bronchial secretions caused by intubation, mechanical ventilation, and the inability to effectively clear sections. Airway obstruction and lung collapse can complicate the clinical course, resulting in prolonged care in the ICU. CPT is usually prescribed to assist in clearing the secretions obstructing larger airways and help in reinflation of the collapsed parts of the lung.

Selected Intubated Neonates. CPT has acquired a role in the management of low birth weight infants on prolonged ventilatory support. It is important that CPT is applied only when it is clearly indicated, because there is conflicting evidence demonstrating a beneficial effect of better oxygenation and secretion clearance and the potential deterioration of physiological parameters.

Postextubation. CPT is commonly used to prevent postextubation complications. However, it should be noted that the evidence is lacking in the utility of CPT to prevent postextubation complications. Select Patients with Acute Asthma. CPT may have utility in expediting the recovery of ventilated children with asthma and retained secretions in the lung. CPT does not improve lung function in children with acute asthma, and when applied inappropriately in the presence of bronchoconstriction can exacerbate the asthma.

Other Indications. CPT can be used to remove secretion in children with weak respiratory mechanics such as kyphoscoliosis, cerebral palsy, and neuromuscular disorders (e.g., spinal muscular atrophy or muscular dystrophy).

Chest Physiotherapy in Bronchiolitis. Bronchiolitis is a self-limiting viral condition, which commonly affects children in the range of 6 months to 2 years old. The rationale for the use of CPT in infants with acute bronchiolitis is that it will enhance clearance of secretions and improve oxygenation parameters. The use of CPT in the treatment of acute bronchiolitis differs among institutions and countries. Although the evidence for and against the use of CPT is weak, some countries consider it unethical not to use CPT for treatment of bronchiolitis, and other countries do not use it as part of the treatment plan. A recent Cochrane review based on three trials found that there was no significant effect on the clinical scores, duration of oxygen supplementation, and length of stay when CPT using percussion and vibration technique was part of management of bronchiolitis. The studies also did not report any adverse events due to the use of CPT. It was concluded that CPT using percussion and vibration techniques could not be recommended for hospitalized infants with acute bronchiolitis.

Suggested Readings

Balachandran A, Shivbalan S, Thangavelu S. Chest physiotherapy in pediatric practice. Indian Pediatr. 2005;42(6):559–568.
Chalumeau M, Foix-L’Helias L, Scheinmann P, et al. Rib fractures after chest physiotherapy for bronchiolitis or pneumonia in infants. Pediatr Radiol. 2002;32(9):644–647.
Perrotta C, Ortiz Z, Roque M.Chest physiotherapy foracute bronchiolitis in paediatric patients between 0 and 24 months old. Cochrane Database Syst Rev. 2007(1):CD004873.
Wallis C, Prasad A. Who needs chest physiotherapy? Moving from anecdote to evidence. Arch Dis Child. 1999;80(4):393–397.

Book Source Details

• Book Title: Avoiding Common Pediatric Errors
• Author(s): Anthony D Slonim MD, DrPH; Lisa Marcucci MD
• Year of Publication: 2008
• Copyright Details: Avoiding Common Pediatric Errors, Copyright © 2008 Lippincott Williams & Wilkins.

More About Marfan syndrome

• Back to disease: Marfan syndrome: Introduction
• Next Book Extract About Marfan syndrome: Know how to recognize and manage scoliosis because an early diagnosis and treatment are especiallyimportant to prevent serious consequences (Avoiding Common Pediatric Errors)
• More Book Extracts: All Online Books for Marfan syndrome

More Medical Textbooks Online about Marfan syndrome

Review other book chapters online related to Marfan syndrome:

Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.

More About This Book: Title: Avoiding Common Pediatric Errors Authors: Anthony D Slonim MD, DrPH; Lisa Marcucci MD Publisher: Lippincott Williams & Wilkins Copyright: 2008 ISBN: 0-7817-7489-6

 » Next page: Know how to recognize and manage scoliosis because an early diagnosis and treatment are especiallyimportant to prevent serious consequences (Avoiding Common Pediatric Errors)

Rate This Website

What do you think about the features of this website? Take our user survey and have your say:

Website User Survey

Medical Tools & Articles:

Next articles:

• Know how to recognize and manage scoliosis because an early diagnosis and treatment are especiallyimportant to prevent serious consequences (Avoiding Common Pediatric Errors)
• Remember that joint or limb pain, particularly in the lower extremities, may be referred pain from another location (Avoiding Common Pediatric Errors)
• Teething (The 5-Minute Pediatric Consult)
• Surveys relating to Marfan syndrome
• Ask Question about Marfan syndrome

Tools & Services:

• Bookmark this page
• Symptom Search
• Symptom Checker
• Medical Dictionary
• Give your feedback

Medical Articles:

• Disease & Treatments Search
• Misdiagnosis Center
• Full list of interesting articles

Forums & Message Boards

• Ask or answer a question at the Boards:
• I cannot get a diagnosis. Please help.
• Tell us your medical story.
• Share your misdiagnosis story.
• What is the best treatment for my condition?
• See all the Boards.

Enter your search terms Submit search form
Search The Web Search wrongdiagnosis.com

Common Health Mistakes

Symptom
Checker

Search Specialists by State and City