Can we do chest therapy for pneumonia?

From the Guidelines

Chest therapy is not explicitly recommended for pneumonia treatment in the provided guidelines. The guidelines focus on oxygen therapy, monitoring, and supportive care, but do not mention chest therapy as a treatment option 1.

Key Recommendations

• Oxygen therapy should be provided to maintain Pa O2 >8 kPa and Sa O2 >92% 1.
• Patients should be assessed for volume depletion and may require intravenous fluids 1.
• Nutritional support should be given in prolonged illness 1.
• Monitoring of temperature, respiratory rate, pulse, blood pressure, mental status, oxygen saturation, and inspired oxygen concentration is crucial 1.

Considerations

• The guidelines emphasize the importance of monitoring and supportive care, but do not provide evidence for the use of chest therapy in pneumonia treatment 1.
• Chest therapy may be considered in specific cases, such as patients with productive coughs who have difficulty clearing secretions on their own, but this is not supported by the provided guidelines 1.
• Further investigations, including bronchoscopy, may be considered in patients with persisting signs, symptoms, and radiological abnormalities about 6 weeks after completing treatment 1.

From the FDA Drug Label

Acute bronchopulmonary disease (pneumonia, bronchitis, tracheobronchitis)

Yes, chest therapy can be done for pneumonia, as it is listed under the indications for use of mucolytics (INH) solution, USP, as an adjuvant therapy for patients with abnormal, viscid, or inspissated mucous secretions in acute bronchopulmonary disease, which includes pneumonia 2.

From the Research

Chest Therapy for Pneumonia

• The effectiveness of chest therapy for pneumonia is a topic of debate, with various studies yielding different results 3, 4, 5, 6, 7.
• A study published in 1985 found that chest physiotherapy had no objective benefits for patients with primary pneumonia, and may have even prolonged the duration of fever and hospital stay in certain groups of patients 4.
• A 2008 randomised controlled trial found that chest physical therapy did not hasten clinical resolution of acute pneumonia in children, and may have even prolonged the duration of coughing and rhonchi 5.
• Another study published in 2012 found that chest physiotherapy had no clinical benefits for children hospitalised with moderate community-acquired pneumonia, compared to a control group 7.
• However, a 1990 review of the data suggested that chest physiotherapy can be effective in clearing secretions from the lungs of patients with copious secretions, particularly when using techniques such as postural drainage and forced expiration 6.
• A 2007 study found that directed cough is the most effective and important part of conventional chest physical therapy, and that other components such as percussion and shaking add little benefit 3.

Patient Selection

• The patients who may benefit from chest physical therapy are those with airways disease and objective signs of secretion retention, such as persistent rhonchi or decreased breath sounds 3.
• Patients with pneumonia who have difficulty expectorating sputum or have a history of recurrent exacerbations or infections may also benefit from chest physical therapy 3.
• However, the use of chest physical therapy in patients with pneumonia should be individualised, taking into account the patient's specific needs and response to treatment 3, 4, 5, 6, 7.