Abstract

Assessed as up to date: 2007/01/24

Background

Bronchopulmonary hygiene physical therapy is a form of chest physical therapy including chest percussion and postural drainage to remove lung secretions. These are applied commonly to patients with both acute and chronic airway diseases. Despite controversies in the literature regarding its efficacy, it remains in use in a variety of clinical settings. The various forms of this therapy are labour intensive and need to be evaluated.

Objectives

The objective of this review was to assess the effects of bronchial hygiene physical therapy in people with chronic obstructive pulmonary disease and bronchiectasis.

Search methods

We searched the Cochrane Airways Group trials register and reference lists of articles up to January 2007. We also wrote to study authors.

Selection criteria

Randomised trials in which postural drainage, chest percussion, vibration, chest shaking, directed coughing or forced exhalation technique was compared to other drainage or breathing techniques, placebo or no treatment.

Data collection and analysis

Two reviewers applied the inclusion and exclusion criteria on masked publications independently. They assessed the trial quality independently. Only data from the first arm of crossover trials were included.

Main results

The seven included trials involved six comparisons and a total of 126 people. The trials were small and not generally of high quality. The results could not be combined as trials addressed different patient groups and outcomes. In most comparisons, bronchial hygiene physical therapy produced no significant effects on pulmonary function, apart from clearing sputum in chronic obstructive pulmonary disease and in bronchiectasis. An update search carried out in January 2007 did not identify any new studies for inclusion.

Authors' conclusions

There is not enough evidence to support or refute the use of bronchial hygiene physical therapy in people with chronic obstructive pulmonary disease and bronchiectasis.

Author(s)

Jones Arthur P, Rowe Brian H

Summary

Bronchopulmonary hygiene physical therapy for chronic obstructive pulmonary disease and bronchiectasis 

People with acute and chronic airway diseases often have secretions building up in their lungs. Bronchopulmonary hygiene physical therapy (BHPT) is a form of chest physical therapy that uses physical forces such as gravity and chest tapping to remove secretions from the lungs. The therapy is labour intensive. This review of trials found there was not enough evidence to show the benefit of BHPT for people with airway diseases such as chronic bronchitis or bronchiectasis. More research is needed.

Reviewer's Conclusions

Implications for practice 

1) Demonstrable beneficial effects of BHPT have been confined to sputum production and radio-aerosol clearance only.
 2) The impact of BHPT on lung function is not clearly established from studies included in this review. No study found a significant beneficial effect on pulmonary function or PaO2.
 3) It is not possible from the trials reviewed to identify specific patient subgroups that might benefit from BHPT.
 4) Insufficient reporting in publications precludes any comments on the adverse effects or harm associated with BHPT.
 5) In view of the lack of functional improvement and sample sizes of the trials, the research on BHPT is inconclusive. There is insufficient evidence to support or refute administration of BHPT to patients with acute and stable COPD, chronic bronchitis or bronchiectasis.

Implications for research 

The findings of this systematic review leave many unanswered questions.
 1) There is a need to conduct RCTs of sufficient power that examine the effects of the various forms of BHPT, both manual and mechanical.
 2) These trials should be conducted in clearly defined patient groups, with adequate controls, randomization and blinding. In addition, such studies need to measure not only primary efficacy measures such as sputum production, radio-aerosol clearance and pulmonary function. They also should measure symptoms, exercise performance, health status (quality of life), recovery time and relapse rate.
 3) There also is a need to examine various BHPT regimens, rather than a single treatment.

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