Is it necessary to resort to respiratory physiotherapy in case of infant bronchiolitis ? The question arises when 12 of the 13 regions of metropolitan France are currently in the midst of an epidemic phase. Since 2019, the High Authority for Health (HAS) no longer “recommends” respiratory physiotherapy for bronchial clearance “in the event of a first episode”. But what does that mean?
Physio does not cure bronchiolitis…
Bronchiolitis is a viral infection of the respiratory tract, which mainly affects children under the age of two. It is characterized first by a runny nose and a dry cough, then a wet and sometimes wheezy cough that resembles asthma. In some cases, respiratory physiotherapy sessions help relieve the baby’s bronchial tubes. “Respiratory therapy is not a cure for bronchiolitis, and has never claimed to be”recalls Doctor Sydney Sebban, pediatrician and coordinator of the Bronchiolite Île-de-France Network.
… But it decongests the bronchial tubes
But studies show it*: respiratory physiotherapy has a transient effect on bronchial congestion. “To declutter again, you need a new physio session because the virus is still there”, explains Doctor Sebban, who compares this situation to that of taking a doliprane in the event of Covid: “It calms the symptoms but it does not eliminate the virus, and as soon as the effect of the doliprane fades, you have to take one again.”
Respiratory physiotherapy, on the other hand, allows “unclog the lower respiratory tract (trachea, bronchi and bronchioles, editor’s note) of babies”, continues the specialist. The child thus relieved of clutter breathes better, sleeps better and eats better. “But if the child is not cluttered, it is actually useless”.
Understand the HAS opinion
Be careful then not to read the HAS recommendations too quickly and conclude that respiratory physio is never useless, because “some kids need it“. What the HAS says is that studies carried out on hospitalized infants have not demonstrated satisfactory efficacy of respiratory physiotherapy. But only 3-4% of babies with bronchiolitis are hospitalized. What about the other 96-97%? The HAS recognizes this: some children respond to respiratory physiotherapy, and studies are still needed to understand this response.
A partnership between healthcare professionals
Then how decide whether or not physio is needed? On a case-by-case basis, with the help of healthcare professionals. The pediatrician can carry out a respiratory diagnosis, “taking into account the baby’s possible comorbidities, age, history…”lists Dr. Sebban.
And if the pediatrician hesitates, he can absolutely prescribe a respiratory examination by a physiotherapist to find out whether or not the baby’s bronchi are congested. “We must establish trust and a partnership between health professionals for the benefit of the child”advances the specialist.
What are the risks for babies?
And if the professionals are wrong, what are the risks? If physio sessions are prescribed while the child is not encumbered, it will be useless but not dangerous. Because the technique practiced at the physio is that of the Increase of the Expiratory Flow (AFE), without danger for the baby. It replaces “clapping” and vibrations which are contraindicated and “have not been practiced at all for 30 years”reassures Dr. Sebban.
Conversely, if a congested child does not practice physiotherapy, the risk is that of an unnecessary drug prescription and inappropriate use of the emergency room, according to the pediatrician.
While waiting for other scientific studies and new, more complete recommendations, the solution to be favored therefore remains the sharing of information and skills between paediatricians, general practitioners and physiotherapists.
* Bronchial Clearance Physiotherapy in Pediatrics. A Controlled, Randomized, Multicenter Study of the Short-Term Effects on Respiration during Outpatient Care for Infants with Acute Bronchiolitis, Sebban et al.Journal of Child Science, April 2021.
and Evaluation of the effect of respiratory physiotherapy with increased expiratory flow in the management of infants’ first bronchiolitis in the communityEvenou et al., Physiotherapy, Review, July 2017.
Sources:
- Interview with Doctor Sydney Sebban, pediatrician and coordinator of the Bronchiolite Île-de-France Network.
- Acute bronchiolitis: physiotherapy is no longer recommended, High Authority of Health, November 20, 2019
- Editorial More physio in bronchiolitis? Syndey Sebban and Jean-Yves Siriez, The Practitioner’s Review, December 2019
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