Respiratory physiotherapy and bronchiolitis: recommended or not?

Respiratory physiotherapy is no longer recommended for babies under one year old who have their first bronchiolitis. But she continues to have a genuine interest in other children. Which ? At what age ? Who to consult when baby is congested? What can a physiotherapist do?

Long used in babies affected by bronchiolitis, respiratory physiotherapy is no longer systematic todayand even no longer recommended for children under 1 year old making their first episode. When is it still useful ? Contraindicated? For what benefits ? Efficiency ? Answers with Pascale Mathieu, physiotherapist and President of the National Council of the Order of Masseur-Physiotherapists and Dr Frédéric Le Guillou, pulmonologist and President of the French Respiratory Health Association.

What are the indications for respiratory physiotherapy in the event of bronchiolitis?

Respiratory physiotherapy maneuvers to unclog the bronchi are no longer recommended in children under one year old who have a first episode of bronchiolitis.but the respiratory physiotherapist (excluding maneuvers, editor’s note) is effective for keep the child comfortable, improve signs and relieve symptoms in particular by blowing the nose and monitoring the evolution of the child’s condition“says Pascale Mathieu. HAS recommends offering “respiratory physiotherapy only for children who suffer, for example, from a chronic respiratory pathology or a neuromuscular disease. “Respiratory physiotherapy can be effective for the management of bronchiolitis if it is linked to other respiratory pathologies than the classic viral infection for drain secretions. She can soothe the child“confirms Dr Frédéric Le Guillou. “In effect, from several episodes of bronchiolitis, management can be compared to that of asthma and respiratory physiotherapy can be useful to relieve the child by helping him to drain secretions“he adds.

Why is respiratory physio no longer recommended by HAS?

Due to a lack of evidence in the scientific literature, the High Authority of Health (HAS) decided in November 2019 to no longer recommend respiratory physiotherapy aimed at decluttering the bronchi in children under 12 months during the first episode of bronchiolitis. Increasing expiratory flow is not effective in the management of hospitalized infants for acute bronchiolitis. Not having demonstrated its effectiveness for the forms of bronchiolitis treated either on an outpatient basis, it is therefore not recommended. explained the authority. “We must remove the ambiguity. This is not a contraindication but only a recommendation which does not concern all childrenemphasizes Pascale Mathieu. Several unions of physiotherapists had reacted to the publication of the HAS in a communicatedrecalling that “At no time does the HAS say that you should not consult a physiotherapist in the event of bronchiolitis”.

What is the role of the physiotherapist in the event of bronchiolitis?

Parents can consult a physiotherapist who can explain how to split food intake and how help their child breathe better using upper airway clearance techniques (nose blowing), without nasopharyngeal aspirates” answers the physiotherapist. This clearing must be systematic and done several times a day. In adults “we are also working on the volumes by exhaling and then inhaling strongly the patient to keep volume inside the lungs while working the diaphragm and the muscles of respiration“.

Who to consult if baby is very crowded?

You should first consult the general practitioner in the event of bronchiolitis, insist on cleaning the baby’s nose, ventilate the room, split the food if he has difficulty eating” recommends Dr Frédéric Le Guillou, pulmonologist. “The physiotherapist can also refer the parents to the emergency room if necessary. Follow-up by a physiotherapist allows avoid many unnecessary emergency visits and the risk of saturation of health services, especially in winter“recalls the physiotherapist.

“In case of bronchiolitis, the physiotherapist receives the parents and the child, asks about the baby’s food, sleep, vomit, cough, presence or absence of diarrhea, or shortness of breath” explains the physiotherapist. “Then he undresses the child and examines it : he watches the respiratory and heart rate, listens if there is whistling, if the nose is congested, if the belly hollows when the baby breathes, if he is in respiratory distress“continues our interlocutor. All the signs then make it possible to know what action to take. If hospital care is not useful, “we proceed to nose blowing which is essential and which parents often do not dare to do. Physiotherapy decluttering techniques can also be used in cases where the baby needs them. (more than a year, repeated episodes of bronchiolitis, editor’s note)” adds our interlocutor.

From what age can respiratory physiotherapy be practiced?

Respiratory physio maneuvers aimed at clearing the bronchi of a child cannot be practiced before the age of one year, unless the child suffers from a chronic respiratory pathology, a neuromuscular disease…

How long does respiratory physiotherapy last in the event of bronchiolitis?

We consult the time required. “Sometimes 3 visits to the physiotherapist are enough. If the signs persist, the baby can be seen for a week. There is no predefined duration“answers the physiotherapist.

What are the indications for respiratory physiotherapy in adults?

In adults, respiratory physiotherapy is indicated in case of respiratory diseases (COPD for example), bronchitis, cystic fibrosis, after-effects of thoracic surgeries (lung cancer, pleurisy) or cardiac operation leading to mobility difficulties of the rib cage and for pulmonary pathologies. The respiratory physio will drain bronchial secretions to avoid superinfection“says the pulmonologist.

What are the contraindications of respiratory physiotherapy?

Pathologies linked to a bone fragility, such as brittle bone disease, are contraindications to respiratory physiotherapy. “heart failure is also a contraindication to respiratory physio. And you have to be careful not to traumatize the child. Some practices can be experienced as violent, sometimes. It should not be done for babies under one year old during a first episode of bronchiolitis” indicates Frédéric Le Guillou in accordance with the recommendations of the HAS of 2019.

Is respiratory physiotherapy covered in the event of bronchiolitis?

Respiratory physiotherapy is not reimbursed in case of bronchiolitis in the baby.

Thank you to Pascale Mathieu, physiotherapist and President of the National Council of the Order of Masseur-Physiotherapists and to Dr Frédéric Le Guillou, pulmonologist and President of the Association Santé Respiraire France.

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