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Bronchiolitis
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Bronchiolitis - January 25, 2003 8:49:00 PM
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yiji
Posts: 10
Joined: July 11, 2002
Status: offline
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Hello all, think I need help for this question. What is the physiotherapy management for bronchiolitis? I have read several text, they either mentioned it as a self-resolving disease or the treatments are found to be not helpful. Are there any literatures available that proves the usefulness of certain techniques? I've tried Medline, Pubmed and several sites for info so far. Will be really grateful if someone can just guide me to the right direction. Thanks!
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Re: Bronchiolitis - January 26, 2003 5:24:00 AM
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jma
Posts: 2310
Joined: August 24, 2000
From: NY
Status: offline
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Hello,
Your search may have been made a little easier if you chose different terms to look under. For example, entering bronchiolitis and then combining it with physical therapy produced no matches. However, combine bronchiolitis and rehabilitation produced three articles, although one of them may be what you are looking for. Different search strings will yield different results.
In addition, according to, Frownfeltzer's book,"Principles and Practice of Cardiopulmonary Physical Therapy", 3r ed, pg.477, the following is quoted. "Physical Therapy treatment should promote mucociliary support and the removal of secretions and mucus to central airways, promote alveolar expansion and ventilation, optimize ventilation and perfusion mathcing and gas exchange, and reduce the risk of infection".
Here are the articles found from pubmed:
1: Porter AL. Related Articles, Links
Physiotherapy in the treatment of bronchiolitis and broncho-pneumonia in babies and young children.
Physiotherapy. 1967 Oct;53(10):333-5. No abstract available.
PMID: 6080651 [PubMed - indexed for MEDLINE]
2: Burioka N, Sugimoto Y, Suyama H, Hori S, Chikumi H, Sasaki T. Related Articles, Links
Clinical efficacy of the FLUTTER device for airway mucus clearance in patients with diffuse panbronchiolitis.
Respirology. 1998 Sep;3(3):183-6.
PMID: 9767617 [PubMed - indexed for MEDLINE]
3: Todd J, Bertoch D, Dolan S. Related Articles, Links
Use of a large national database for comparative evaluation of the effect of a bronchiolitis/viral pneumonia clinical care guideline on patient outcome and resource utilization.
Arch Pediatr Adolesc Med. 2002 Nov;156(11):1086-90.
PMID: 12413334 [PubMed - indexed for MEDLINE]
Hope these help.
JMA
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Re: Bronchiolitis - January 26, 2003 7:46:00 AM
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coloradojulie
Posts: 413
Joined: November 10, 2002
From: colorado usa
Status: offline
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I did some respiratory PT in Canada in ICU etc at the beginning of my career...it seems, back then (8 years ago) that there wasn't alot of literature or true techniques to manage patients with respiratory complications. Deep breathing and coughing was about as far as it went! Postural drainage and percussion work were used, but never really found effective. Depending on the diagnosis, I would use a combination of techniques.
Bronchiolitis, as I recall is imflammation of the bronchioles, the passages leading to the alveoli. In any inflammatory condition of the lungs, percussion and vibration can be aggravating, generating bronchospasm and irritability. As posted above you want to optimize perfusion and oxygenation ratios. You can focus on secretion control and air entry.
If it is a productive condition, meaning, the patient is producing sputum there are techniques you can use to enhance clearance. Coughing a lot is generally a good thing but may actually aggravate the inflammation if overdone. Houghing is a good alternative, it is a rapid exhalation as the patient makes a "hough" sound. This can bring secretions to the point of swallowing or "hacking" up. Sputum can tell you alot about the problem too, analyze it, is it green (secretions have been present for along time), yellow (infection is active)etc.
Deep, controlled diaphramatic breathing can help keep oxygenation up, rapid, as is used by the incentive spirometer (a device, when we did a lit review had very little use, or effectiveness) can actually aggravate this condition because the patient does forceful inhalation. If the patient is withit and compliant, they should be able to do deep breath work as above without the spirometer (which is a stupid stupid thing)...
Like any inflammation you don't want to tax it, but at the same time you need to get the secretions out...try some of the gentle things above...Respiratory PT was a dying thing, I am glad to hear you looking into it!
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Re: Bronchiolitis - January 30, 2003 4:49:00 AM
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Dr.Wagner
Posts: 1237
Joined: January 24, 2003
From: Indianapolis
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Considering brochiolitis (caused by RSV) is an EXTREMELY common URI of children in particular ages 6 mos to 3 years every case simply does not warrent the need for therapy of any kind other than supportive.
In the cases where the children need to be hospitalized, it is bronchoconstriction and copious rhinnorea coupled with hypoxia that that are the primary concerns.
Chest PT may have its place with the patient with significant comorbidities such as congenital lung disease than with the run of the mill RSV patient.
Dr. Wagner, DO
and former practicing PT
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Re: Bronchiolitis - February 26, 2003 8:06:00 PM
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yiji
Posts: 10
Joined: July 11, 2002
Status: offline
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Thank you everyone for your kind responses. I'll be looking into the info I've gotten. Thanks once again.
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