Chest physiotherapy is not clinically indicated for infants receiving outpatient care for acute wheezing episodes

Abstract

Aim: To evaluate the effectiveness of chest physiotherapy (CPT), which provides slow and long expiratory flow and assisted cough techniques, in infants receiving outpatient care for acute wheezing episodes.

Methods: Forty-eight infants with moderate acute wheezing episodes were randomised to receive either salbutamol MDI with CPT (n = 25) or without CPT (n = 23). The clinical score and SpO2 levels were recorded, before and after treatment, in a blinded design. The primary outcome was discharge after the first hour of treatment: clinical score ≤5/12 and SpO2 ≥ 93%. Secondary outcomes were the number of admissions to hospital after the second hour, use of oral corticosteroid bursts and admissions to hospital on day seven.

Results: There were no differences between children with and without CPT in discharge rate (92% vs. 87%), clinical score (median [IQR]: 2.8 [2.2-3.3] vs. 3.4 [2.8-4.1]) and SpO2 = (96.4 [95.7-97.1] vs. 96.0 [94.9-96.5]) after the first hour of treatment or in the number of hospital admissions after the second hour. No differences were observed at days seven and 28 following treatment.

Conclusion: There was no evidence of clinical benefits from these specific CPT techniques for infants receiving outpatient care for acute wheezing episodes.

Keywords: Acute wheezing episode; Chest physiotherapy; Infants; Outpatient.