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Chest physiotherapy using passive expiratory techniques does not reduce bronchiolitis severity: a randomised controlled trial

Leis, Patricia
Bouchardy, Marie
Oberli, Christine
Sourial, Hendrika
Friedli-Burri, Margrit
Barazzone Argiroffo, Constance
Published in European Journal of Pediatrics. 2012, vol. 171, no. 3, p. 457-62
Collection Open Access - Licence nationale Springer
Abstract Chest physiotherapy (CP) using passive expiratory manoeuvres is widely used in Western Europe for the treatment of bronchiolitis, despite lacking evidence for its efficacy. We undertook an open randomised trial to evaluate the effectiveness of CP in infants hospitalised for bronchiolitis by comparing the time to clinical stability, the daily improvement of a severity score and the occurrence of complications between patients with and without CP. Children <1 year admitted for bronchiolitis in a tertiary hospital during two consecutive respiratory syncytial virus seasons were randomised to group 1 with CP (prolonged slow expiratory technique, slow accelerated expiratory flow, rarely induced cough) or group 2 without CP. All children received standard care (rhinopharyngeal suctioning, minimal handling, oxygen for saturation ≥92%, fractionated meals). Ninety-nine eligible children (mean age, 3.9 months), 50 in group 1 and 49 in group 2, with similar baseline variables and clinical severity at admission. Time to clinical stability, assessed as primary outcome, was similar for both groups (2.9 ± 2.1 vs. 3.2 ± 2.8 days, P = 0.45). The rate of improvement of a clinical and respiratory score, defined as secondary outcome, only showed a slightly faster improvement of the respiratory score in the intervention group when including stethoacoustic properties (P = 0.044). Complications were rare but occurred more frequently, although not significantly (P = 0.21), in the control arm. In conclusion, this study shows the absence of effectiveness of CP using passive expiratory techniques in infants hospitalised for bronchiolitis. It seems justified to recommend against the routine use of CP in these patients.
Keywords Acute DiseaseBronchiolitisViral/complications/therapyFemaleHospitalizationHumansInfantInfantNewbornKaplan-Meier EstimateMaleRespiratory Syncytial Virus Infections/complications/therapyRespiratory Syncytial VirusHumanRespiratory Therapy/methodsSeverity of Illness IndexTreatment Outcome
PMID: 21927808
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Research groups Epidémiologie clinique (115)
Facteurs influençants le développement pulmonaire: étude translationnelle chez l'animal et l'homme (182)
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ROCHAT, Isabelle et al. Chest physiotherapy using passive expiratory techniques does not reduce bronchiolitis severity: a randomised controlled trial. In: European Journal of Pediatrics, 2012, vol. 171, n° 3, p. 457-62. doi: 10.1007/s00431-011-1562-y https://archive-ouverte.unige.ch/unige:26306

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Deposited on : 2013-02-08

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