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. 2025 Oct 8;25(1):459.
doi: 10.1186/s12890-025-03801-y.

Blowing devices, resources and incentive screens during respiratory physiotherapy: a systematic review

Thaise Helena Cadorin  1 , Juliana Cardoso  1 , Tayná Castilho  2 , Gabriela Castilhos Ducati  1 , Renata Maba Gonçalves Wamosy  1 , Camila Isabel Santos Schivinski  3   4
Affiliations

Blowing devices, resources and incentive screens during respiratory physiotherapy: a systematic review

Thaise Helena Cadorin et al. BMC Pulm Med. .

Abstract

Introduction: Blowing devices, resources, and incentive screens are routinely used in respiratory physiotherapy, but evidence of their effects remains scarce. This study aimed to investigate the effects of blowing strategies on various clinical outcomes during physiotherapy in individuals with respiratory disorders.

Method: This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (CRD42022370442) and included experimental and quasi-experimental studies, including pilot studies, on the effects of blowing strategy interventions. Were considered studies published in English, Spanish, or Portuguese with no date restrictions.

Results: The database search identified 838 records, of which 17 studies published between 1985 and 2024 were selected. The total sample included 823 individuals aged between 3 and 95 years. The blowing strategies used were the blowing bottle, balloon, party whistle, pinwheel, and visual feedback interfaces. Positive effects on various clinical outcomes were observed: five studies reported increased peripheral oxygen saturation after using the blowing bottle, pinwheel, balloon, and party whistle; three studies reported reduced respiratory rates after using the party whistle, balloon, and bubble blowing; two studies reported lower heart rates after using the party whistle and bubble blowing; two studies reported a reduction in dyspnea after using the blowing bottle and balloon; one study reported increased interest in physiotherapy treatment after using visual feedback blowing; and one study found a shorter hospital stay after using the blowing bottle.

Conclusion: Blowing strategies are used in physiotherapy across different populations, which contributes to the heterogeneity of findings. These strategies have positive effects on certain clinical outcomes, such as peripheral oxygen saturation and respiratory and heart rates. However, the results vary for pulmonary function, dyspnea, and length of hospital stay, depending on the type of device and the target population, which suggests the need for further studies for its use in clinical practice.

Keywords: Games and toys; Patient care; Respiratory diseases.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of the studies included
See this image and copyright information in PMC

References

    1. Niederman MS, Torres A. Respiratory infections. Eur Respir Rev. 2022;31(166):220150. 10.1183/16000617.0150-2022. - PMC - PubMed
    1. Safiri S, Mahmoodpoor A, Kolahi AA, Nejadghaderi SA, Sullman MJM, Mansournia MA, et al. Global burden of lower respiratory infections during the last three decades. Front Public Health. 2023;9(10):1028525. 10.3389/fpubh.2022.1028525. - PMC - PubMed
    1. Cavallazzi R, Ramirez JA. How and when to manage respiratory infections out of hospital. Eur Respir Rev. 2022;31(166):220092. 10.1183/16000617.0092-2022. - PMC - PubMed
    1. Wang J, Wang R, Xie Z. Rethinking paediatric respiratory infections: the role of mixed pathogen infections. Rev Med Virol. 2025;35(2):e70021. 10.1002/rmv.70021. (PMID: 40000823). - PubMed
    1. Centeno-Cortez AK, Díaz-Chávez B, Santoyo-Saavedra DR, Álvarez-Méndez PA, Pereda-Sámano R, Acosta-Torres LS. Fisioterapia respiratoria en pacientes adultos post-COVID-19: revisión sistemática de la literatura. Rev Med Inst Mex Seguro Soc. 2022;60(1):59–66 (Spanish. PMID:35271227; PMCID:PMC10395915). - PMC - PubMed

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