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174 APPENDICES Physiotherapy KCE reports vol.40 Table 13 Bronchiolitis in infants and children: treatment modalities applied by Belgian ambulatory physiotherapists and evidence-based literature Treatment modality Frequency (proportion ± accuracy) Chest percussion 74 ± 09% Education of the parents 74 ± 09% Assisted coughing 67 ± 10% Aerosol 64 ± 10% Forced exhalation techniques Type of evidence No evidence for nor against Evidence for (weak) No evidence for nor against Evidence against (moderate to strong) except in specific situations No evidence for nor against Evidence available in the literature on physiotherapy of bronchiolitis in infants and children There is weak to moderate evidence that chest percussion should not be recommended as it has not been found to be helpful. Weak evidence was found in educating the family on basic pathophysiology and expected clinical course of bronchiolitis, on limiting exposure to contagious settings and siblings, and on importance on hand washing in all settings. Education of the family on calling the primary care provider when objective signs of worsening clinical status are present is also recommended by an experts consensus. Educating the family on eliminating exposure to tobacco smoke is also recommended. There is weak to moderate evidence that assisting coughing should not be recommended as it has not been found to be helpful. Assisting coughing is however recommended by experts consensus from French-speaking European countries. There is moderate to strong evidence that scheduled or serial albuterol aerosol therapies should not be routinely used. However, single administration trial inhalation of epinephrine or albuterol may be considered when there is a family history of allergy, asthma or atopy. Inhalation therapy should not be repeated nor continued in absence of clinical improvement between 15 to 30 minutes after the first trial inhalation. Aerosol therapy with saline and cool mist therapy should not be recommended as they have not been found to be helpful. 61 ± 10% ? No information was available in the literature review.
KCE reports vol.40 APPENDICES Physiotherapy 175 Table 13 Bronchiolitis in infants and children: treatment modalities applied by Belgian ambulatory physiotherapists and evidence-based literature Treatment modality Frequency (proportion ± accuracy) Postural drainage 61 ± 10% Chest vibration 61 ± 10% Acceleration of expiratory flow Nasopharyngeal decongestion Slow prolonged expiration Slow increase of expiratory flow Type of evidence No evidence for nor against No evidence for nor against Evidence available in the literature on physiotherapy of bronchiolitis in infants and children There is weak to moderate evidence that postural drainage should not be recommended as it has not been found to be helpful. There is weak to moderate evidence that chest vibration should not be recommended as it has not been found to be helpful. 38 ± 10% ? No information was available in the literature review. 33 ± 10% 31 ± 10% 21 ± 08% Specific devices 10 ± 06% Experts consensus Experts consensus Experts consensus No evidence for nor against Nasopharyngeal decongestion combined with local instillation of saline is recommended by an experts consensus as an upper airway clearance method that can be performed by physiotherapists. Slow prolonged expiration is recommended as one of the preferred techniques in the treatment of bronchiolitis in infants and children by experts consensus from French-speaking European countries. Slow increase in expiratory flow is recommended as one of the preferred techniques in the treatment of bronchiolitis in infants and children by experts consensus from French-speaking European countries. There is insufficient evidence from the literature to conclude that specific devices such as CPAP (non invasive Continuous Positive Airway Pressure) and CNEP (Continuous Negative Extrathoracic Pressure) are beneficial in acute hypoexemic respiratory failure in paediatric patients. Potential risks of CPAP and CNEP have not been studied.
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