Chest physiotherapy and bronchiolitis: a systematic review

Bronchiolitis is a viral infection that affects lower airways of infants younger than 2 years old, leading to a build-up of secretions in the bronchial tree, oedema and airways obstruction. Children affected by bronchiolitis may develop progressive breathing and feeding difficulties, sometimes requiring hospitalization.

To date, bronchiolitis therapy consists of support through oxygen therapy and fluid therapy; further pharmacological treatments are not recommended by current guidelines.

A recent Cochrane review published in April 2023 analysed 17 randomized controlled trials to determine the efficacy of different types of chest physiotherapy in children younger than 2 years old with bronchiolitis

Data analysis demonstrated with high certainty that conventional chest physiotherapy (postural drainage, vibrations and percussion) has no effects on the severity of bronchiolitis, on respiratory parameters and on the duration of oxygen therapy or hospitalization.

On the other hand, evidence of low certainty has been reported regarding the use of slow expiratory techniques: they seem to improve bronchiolitis severity score, especially in children with moderate bronchiolitis treated in hospital, without influencing the length of hospitalization.

Finally, the evidence regarding new physiotherapy techniques such as instrumental physiotherapy or rhinopharyngeal retrograde technique is scarce but they seem to help the removal of secretions especially when associated with slow expiratory techniques, leading to actual clinical benefit.

BIBLIOGRAPHY

Roqué-Figuls, M., Gine-Garriga, M., Rugeles, C. G., Perrotta, C., & Vilaró, J. (2023). Chest physiotherapy for acute bronchiolitis in paediatric patients between 0 and 24 months old. Cochrane Database of Systematic Reviews, (4).