Who needs chest physiotherapy? Moving from anecdote to evidence

“One case which I had was that of a newborn child with acquired atelectasis, which required my presence, or that of my assistant, for 24 hours. In such cases there is nothing, I believe, as efficacious as flagellation. I usually tell the attendant to take a rubber band and flip the soles of the feet whenever the child begins to tire of breathing.”

Dr Sanders. In: Disturbances of respiration in the newborn. Transactions of the American Pediatric Society 1903;15:47.

At the beginning of this century, paediatrics was an art. Skills were learnt from a mentor, picking up tips and anecdotes while standing at your master’s side. Now, as practitioners of child health in the final years of this same century, life has changed. Anecdote and word of mouth have lost credibility and are replaced by scientific scrutiny and the rigour of evidence from carefully controlled and sufficiently powerful trials. We do our best to find the truth, but in many areas of care there remains a dearth of sufficient evidence. Often in the closets of our own practices, we continue to do what our teachers taught us and what, over time, we believe works.

The central function of chest physiotherapy in paediatric respiratory disease is to assist in the removal of tracheobronchial secretions. The intention is to remove airway obstruction, reduce airway resistance, enhance gas exchange, and reduce the work of breathing. In the acute situation, recovery should be hastened and in the child with a chronic respiratory disorder, the progression of the lung disease is hopefully delayed.

Chest physiotherapy can improve a patient’s respiratory status and expedite recovery. But in certain situations it may be a useless intervention or even harmful—perhaps by increasing bronchospasm, inducing pulmonary hypertension, repositioning a foreign body, or destabilising a sick infant. What …