Chest Physiotherapy Not Effective in Infants with Acute Bronchiolitis

Findings from a study published in PLoS Medicine indicate that a physiotherapy technique commonly used to treat hospitalized infants with acute bronchiolitis does not reduce time to recovery.

Vincent Gajdos and colleagues conducted a multicenter, randomized, controlled study in seven pediatric departments located in France, where national guidelines recommend a specific type of physiotherapy combining the increased exhalation technique (IET) and assisted cough (AC). The researchers sought to “evaluate the efficacy of chest physiotherapy (IET AC) in previously healthy infants hospitalized for a first episode of acute bronchiolitis.”

The researchers enrolled 496 infants aged 15 days to two years who were admitted to a hospital between October 2004 and January 2008 for a first episode of acute brochiolitis. Subjects received either IET AC (intervention group) or nasal suction (NS, control group) three times a day from physiotherapists three times a day.

According to Gajdos and colleagues, the primary outcome was time to recovery, defined as eight hours without oxygen supplementation associated with minimal or no chest recession, and ingesting more than two-thirds of daily food requirements. Secondary outcomes included intensive care unit admissions, artificial ventilation, antibiotic treatment, description of side effects during procedures, and parental perception of comfort.

The median time to recovery was 2.31 days for the control group and 2.02 days for the intervention group, “indicating no significant effect of physiotherapy,” according to the researchers. Frequency of vomiting and transient respiratory destabilization was higher in the IET AC group during the procedure, and no difference between groups in bradycardia with or without desaturation was noted during the procedure.

Interestingly, parents reported that the procedure was more arduous in the group treated with IET; however, no difference was found regarding the assessment of the child’s comfort between the two groups. No evidence of differences between groups in intensive care admission, ventilatory support, and antibiotic treatment was observed.

The researchers concluded that “physiotherapy sessions with the IET technique in infants hospitalized for a first episode of bronchiolitis provided no evidence that this treatment shortened time to recovery.” These results, they said, do not support the recommendation that chest physiotherapy be routinely performed in hospitalized infants with acute bronchiolitis. Further, Gajdos and colleagues believe that “additional studies are required to explore the effect of chest physiotherapy on ambulatory populations and for infants without a history of atopy.”

Click here to view the full text of the PLoS Medicine study.