Airway clearance techniques to treat acute respiratory disorders in previously healthy children: where is the evidence?

Abstract

Airway clearance techniques are an important part of the respiratory management in children with cystic fibrosis, bronchiectasis and neuromuscular disease. They are also, however, frequently prescribed in previously healthy children with an acute respiratory problem with the aim to speed up recovery. The current review explores the evidence behind this use of airway clearance techniques in children without underlying disease. Few studies have been performed; many different techniques are available and the therapies used are often poorly specified. It is necessary to name the specific airway clearance technique used in treatment rather than to just state "chest physiotherapy," a term that is often confused with chest clapping or vibration plus postural drainage. There is little evidence that airway clearance techniques play a role in the management of children with an acute respiratory problem. Physicians routinely prescribing airway clearance techniques in previously healthy children should question their practice.

Chest Physical Therapy in Acute Viral Bronchiolitis: An Updated Review

“…[30][31][32][33][34] The 2012 Cochrane review showed no significant benefit from conventional CPT on clinical score or hospital stay, and conventional CPT in acute viral bronchiolitis is no longer recommended. [35][36][37] In France, increased-exhalation technique has been widely used in various ways since the 1970s. [38][39][40] A robust thoraco-abdominal pressure is applied to mimic the forced expiratory technique.…”

Continuing to Challenge Practice to Be Evidence Based

“…CPT has been used as an adjunct to decrease severity, length of illness, and improve outcomes of this serious disease. However, De Boeck and colleagues 73 found little evidence to support use of CPT to treat pneumonia. Studies that supported the use of CPT to treat pneumonia did not have well-defined inclusion criteria and were published in the 1980s.…”

“…Studies have not demonstrated improvement in signs and symptoms, decreased length of illness, decreased LOS, 75,76 or reduction in duration of fever. 73 Furthermore, pneumonia occurs in the peripheral airways; therefore, secretions are not located in an area where CPT could facilitate movement of secretions out of the airways. 73,74 In a Cochrane database review, Chaves et al 77 looked at CPT in the treatment of pneumonia in which the primary outcome criteria were mortality, LOS, and time to clinical resolution.…”

“…72 Loosening secretions aids in airway clearance, decreases the work of breathing, improves gas exchange, and decreases the duration of illness. 73 The evidence regarding conventional CPT, involving percussion, postural drainage, and coughing in various common pediatric respiratory diagnoses is reviewed. Limitations in evaluating the evidence include the fact that early studies often used custom-made respiratory scores and subjective measures such as less coughing or improved oral intake 73 making it difficult to compare study findings.…”

“…73 The evidence regarding conventional CPT, involving percussion, postural drainage, and coughing in various common pediatric respiratory diagnoses is reviewed. Limitations in evaluating the evidence include the fact that early studies often used custom-made respiratory scores and subjective measures such as less coughing or improved oral intake 73 making it difficult to compare study findings. Additionally, because of the active components of CPT, blinded trials are nearly impossible.…”