Respiratory physiotherapy can be used in adults and children in order to improve breathing, for example in the case of chronic bronchitis, asthma, etc. Zoom on the techniques, indications and how a session takes place.
Definition: what is respiratory physiotherapy?
Respiratory physiotherapy is a technique based on performing external maneuvers (pressure on the thorax, vibration…) to improve breathing. It can increase the elimination of secretions present in excess in the respiratory tract (in the event of chronic bronchitis or bronchiolitis for example). Respiratory physiotherapy is performed in adults and children.
Ventilation and drainage techniques called “controlled expiratory flow”
These manual techniques consist of move secretions up to the proximal airways (of the mouth) : ventilation and drainage are the most used. They aim to obtain an inspiratory volume large enough to be able to generate, during expiration, an effective expiratory flow favoring the mobilization of secretions. The ventilation technique is, for example, used in the event of asthma or of bronchitis chronicles.
Vibration techniques (clapping)
These techniques are not almost no longer used for lack of convincing results in scientific studies on the subject. The thoracic percussions like the “clapping” make it possible to take off the bronchial secretions which prevent from breathing correctly. Also called “claquade”, this technique is practiced by a professional who exerts percussions of more or less intensity with the palms of the hands at the level of the trunk.
What are the indications for respiratory physiotherapy?
Respiratory physiotherapy is used when the patient suffers from cough, congestion, difficulty with effort. For example in case of:
- cystic fibrosis
- pneumothorax
- asthma
- COPD
- pulmonary emphysema
- respiratory failure
- pleurisy
- tuberculosis
- bronchiectasis or bronchial dilatation (DDB)
- neuromuscular disorders
- pneumonia
Respiratory physiotherapy and bronchiolitis
Long authorized in France to unclog the bronchial passages of infants with bronchiolitis, respiratory physio is no longer recommended by health authorities since November 2019. In question, the lack of evidence in the scientific literature in favor of a beneficial effect of this treatment, as explained by the High Authority of Health (HAS). The analysis of three large studies showed that the duration of hospitalization of affected infants was not reduced by respiratory physiotherapy. In addition, the HAS emphasizes that conventional physiotherapy (postural, clapping) is responsible forside effects significant while “THE techniques by gently accelerating expiratory flows are better tolerated“. The experts recognized that its interest could be discussed in the child in the event of comorbidities, for example if, in addition to bronchiolitis, he suffers from a chronic respiratory pathology or a neuromuscular pathology. Several unions of physiotherapists wanted to recall in a communicated that their role was not confined solely to bronchial drainage in the event of bronchiolitis. “The physiotherapist examines, assesses and redirects the baby to the emergency room or the attending physician if necessary. He reassures and accompanies the parents.” And point out that “at no time does the HAS say that you should not consult a physiotherapist in the event of bronchiolitis”.
Respiratory physiotherapy sessions can take place to the hospital Or in the office of the physiotherapist. He examines the patient, questions him and consults his medical file if he has one. He then begins manipulations (manually or using apparatus or accessories) on the patient who is either seated, semi-seated or lying down. He also dispenses advice in order to educate the patient in the daily experience of his illness. The duration of the session varies according to the patient, as does the frequency of consultations. They can be covered by Social Security and mutual insurance companies.