Impact of physical therapy on different types of bronchiolitis, patients, and care settings: A systematic review

ABSTRACT Bronchiolitis is defined as an acute episode of wheezing that occurs in the context of a respiratory condition, usually of viral origin, with a high incidence in children under 2 years of age. Considering that the role of physical therapy has been questioned in this context, it is paramount to clarify and differentiate the impact of different physical therapy techniques employed for each type of bronchiolitis, patient, and care settings. A systematic review was performed, searching the Science Direct, MEDLINE/PubMed, and SciELO databases on physical therapy techniques in children up to 2 years of age with a bronchiolitis episode. Six observational studies, 5 experimental studies without control group and 15 with control group, involving 3339 individuals were included. Fourteen studies use inpatient samples, six analyze hospital and ICU samples, and six studied outpatient samples. Among the most commonly used respiratory physical therapy techniques are the prolonged slow expiration (PSE) associated with provoked coughing (PC), expiratory flow increase (EFI), retrograde rhinopharyngeal clearance (RRC) and postural drainage (PD). Positive results were found regarding respiratory physical therapy techniques, namely RRC, PSE and EFI or PC, on airway permeabilization, promotion of bronchial hygiene, hospital stay, oxygen saturation, clinical score, heart rate, respiratory rate, and need for oxygen therapy. As limitations of the study, it is highlighted the lack of studies with robust and comparable methodologies to draw conclusions with greater certainty, especially regarding different severities of the pathology, thus supporting the personalization and adequacy of interventions in clinical practice.

摘要 毛细支气管炎（bronchiolitis）是指继发于呼吸道疾病背景下的急性喘息发作，其病因多为病毒性，在2岁以下儿童中具有较高发病率。鉴于当前该领域内物理治疗的作用尚存争议，明确并区分不同物理治疗技术针对不同类型毛细支气管炎、不同患者及不同诊疗场景的干预效果，具有重要临床意义。本研究开展了一项系统综述，检索了Science Direct、MEDLINE/PubMed及SciELO数据库中针对2岁以下毛细支气管炎患儿的物理治疗技术相关文献。最终纳入6项观察性研究、5项无对照实验研究及15项对照实验研究，共涉及3339名研究对象。其中14项研究以住院患者为研究样本，6项研究同时分析住院及重症监护病房（ICU）患者样本，另有6项研究针对门诊患者样本。临床中最常用的呼吸物理治疗技术包括：联合诱发咳嗽（provoked coughing，PC）的延长缓慢呼气（prolonged slow expiration，PSE）、呼气流量增加（expiratory flow increase，EFI）、逆行鼻咽清除（retrograde rhinopharyngeal clearance，RRC）及体位引流（postural drainage，PD）。研究结果显示，呼吸物理治疗技术（如RRC、PSE、EFI或PC）可有效改善气道通畅性、促进支气管卫生管理、缩短住院时长、提升血氧饱和度、优化临床评分、降低心率与呼吸频率，并减少氧疗需求。本研究的局限性在于，目前缺乏方法学严谨且具备可比性的相关研究，难以得出更具确定性的结论，尤其是针对不同严重程度的病理状态，这也提示临床实践中需进一步推进干预措施的个体化与适配化。