What is the role of chest physiotherapy (Chest Physical Therapy) in the management of bronchiolitis?

Chest Physiotherapy Should Not Be Used in Bronchiolitis

Chest physiotherapy has no role in the routine management of bronchiolitis and should not be performed. 1, 2

Evidence-Based Recommendation

The American Academy of Pediatrics explicitly recommends against routine use of chest physiotherapy in bronchiolitis management. 1 This recommendation is based on:

• Aggregate evidence quality: Level B (randomized controlled trials with limitations) 1
• A Cochrane Review found no clinical benefit using vibration, percussion, or passive expiratory techniques 2
• The theoretical benefits of secretion clearance and atelectasis prevention do not translate to actual clinical improvement 1

Why Chest Physiotherapy Fails in Bronchiolitis

The pathophysiology of bronchiolitis involves airway edema and sloughing of respiratory epithelial cells causing ventilation-perfusion mismatch, not simply mucus plugging that can be mechanically cleared. 1 Physical manipulation of the chest does not address the underlying inflammatory process and provides no measurable benefit in:

• Oxygen saturation improvement 2
• Length of hospital stay 2
• Clinical symptom resolution 1

Potential Harm

Recent evidence suggests chest physiotherapy may actually be associated with worse outcomes. One study found percussion and postural drainage use was associated with rapid response team activation (odds ratio 5.06,95% CI: 1.88-13.63). 3 This suggests the intervention may cause clinical deterioration rather than improvement.

What Actually Works: Evidence-Based Supportive Care

Instead of chest physiotherapy, focus on interventions proven to benefit outcomes:

• Gentle nasal suctioning only as needed for symptomatic relief, avoiding deep suctioning which is associated with longer hospital stays 4
• Supplemental oxygen only if SpO₂ persistently falls below 90%, maintaining SpO₂ ≥90% 1, 2, 4
• Hydration assessment with IV or nasogastric fluids for infants unable to feed safely due to respiratory distress 2, 4
• Minimal handling and supportive care as the mainstay of treatment 5, 6

Common Clinical Pitfall

Despite clear guideline recommendations, chest physiotherapy continues to be used in clinical practice. 3 This represents low-value care that wastes resources without improving patient outcomes and may potentially cause harm. 5, 3