Effects of chest physical therapy on lung function in children recovering from acute severe asthma

Abstract

The effects of chest physical therapy in acute severe asthma in children have been studied in 38 children aged 6 to 13 years in a randomized placebo controlled trial. The study began between 6 and 24 hours after admission to hospital; 19 children received chest physical therapy (PT) and 19 children received placebo visits. Each child had 4 treatments over 2 days which were preceded by nebulized salbutamol. Lung volumes and flow rates were measured in a body plethysmograph before salbutamol and before and after either PT or placebo on the first and fourth treatments. Throughout the study standard asthma drug therapy was given. In both groups characteristics such as sex, race, age, height, weight, severity, and baseline lung function were similar. Taking into account the baseline, lung function at the end of the study was similar in both groups. Three 12 year old children in the PT group showed improvements in flows above those seen in any children in the placebo group. We conclude that chest PT, when combined with asthma drug therapy, does not improve lung function in most children in this age group with acute severe asthma.

Nonpharmacologic Airway Clearance Techniques in Hospitalized Patients: A Systematic Review

“…24 CPT included relaxation techniques (positioning, lateral costal or diaphragmatic breathing, shoulder relaxation), secretion clearance techniques (postural drainage, coughing, forced expiratory technique, vibration, wing flapping), thoracic mobility exercises, and postural correction exercises.…”

“…14,17,19,24,25,29,32,34,37,40,42,43,44 Three studies reported improved results: a poor quality study of IPV ϩ CPT versus CPT in ICU subjects, with COPD reported better pulmonary function tests in the intervention group 18 ; and a poor quality study of spirometry plus Deep breathing exercises, sustained maximal inspiration, postural drainage, manual percussion Ambrosino 32 …”

“…For CPT compared to standard care, 5 studies (3 of poor quality, and 2 of fair quality) reported no significant difference. 16,20,21,23,24 A fair quality study reported longer stay in COPD subjects treated with CPT, compared to those treated with IPV. 27 Two studies of the Flutter device reported no significant difference in stay, compared to other standard treatments.…”

“…Deep breathing exercises, sustained maximal inspiration, postural drainage, manual percussion Asher 24 …”

Pediatric Airway Maintenance and Clearance in the Acute Care Setting: How To Stay Out of Trouble

“…The concern would be that you could increase oxygen demand and also stress a patient who is already stressed. 88 How then, do we deal with secretion clearance in patients with acute asthma? Some support the cough and respiratory effort or drive by utilizing noninvasive ventilation to limit fatigue, whereas others utilize PEP therapy to prevent distal airway collapse.…”