Chest Physiotherapy in Pediatrics Patients With Pneumonia
Description of the Condition
Pneumonia is the type of lung infection which is caused by bacteria, viruses, and fungi.
- These foreign microbes are responsible for inflammation of the lungs causing fluid collection in the alveoli and thus hamper the ventilation-perfusion ratio.
- As a protective mechanism, the accumulation of secretions in the airways occurs which worsens clinical symptoms and leads to an increase in airway resistance with each breath.
These signs and symptoms of Pneumonia (fever, tachypnoea, nasal flaring, cough, breathlessness, lower chest wall indrawing, and reduced oxygen saturation) are useful in diagnosing pneumonia. Chest assessment also helps to determine the diagnosis and prognosis of the disease. Chest radiographic images are the gold standard for diagnoses of pneumonia.
Pneumonia is a leading cause of morbidity and mortality in children younger than the age of 5 years worldwide. Annually, there are an estimated 120 million cases of pneumonia worldwide, resulting in as many as 1.3 million deaths. Younger children under the age of 2 in the developing world, account for nearly 80% of pediatric deaths secondary to pneumonia. 
The etiology of pneumonia in the pediatric population can be classified by age-specific versus pathogen-specific organisms. neonates are more prone to have bacterial pneumonia whereas viral pneumonia is more common in toddlers. Community-acquired pneumonia ( CAP) is common among children globally, but incidence and mortality rates are significantly higher in low‐income countries. The factors for increasing incidence and mortality rates in developing countries include prematurity, malnutrition, low socioeconomic status, exposure to tobacco smoke, and child care attendance.
The original guidelines by WHO classified the severity of illness using simple clinical signs of children 2 to 59 months of age into four categories:
- Children with cough and cold who did not have signs of pneumonia were classified as “no pneumonia”, and their caregivers were advised on appropriate home care.
- Children with fast breathing were classified as “pneumonia” and were given an oral antibiotic (cotrimoxazole/ amoxicillin-at least 40 mg/kg/dose twice daily or 80mg/kg/day) to take at home for five days.
- Children who had chest indrawing with or without fast breathing were classified as “severe pneumonia” and were referred to the closest health facility for treatment with injectable penicillin.
- Children who had any general danger signs (Not able to drink, persistent vomiting, convulsions, lethargic or unconscious, stridor in a calm child or severe malnutrition) were classified as “severe pneumonia or very severe disease”. These children received the first dose of oral antibiotics and were then urgently referred to a health facility for further evaluation and treatment with parenteral antibiotics.
Supportive and symptomatic management is key and includes supplemental oxygen for hypoxia, antipyretics for fever, and fluids for dehydration. This is especially important for non-infectious pneumonitis and viral pneumonia for which antibiotics are not indicated. Cough suppressants are not recommended.
Description of the Intervention
Chest physiotherapy is a vital constituent of respiratory care. It is used as an important adjuvant treatment of most respiratory illnesses from chronic respiratory illnesses, neuromuscular disease, and mechanically ventilated patients.
Chest physiotherapy is the term for a group of treatments designed to improve respiratory efficiency, promote the expansion of the lungs, strengthen respiratory muscles, and eliminate secretions from the respiratory system.
There are various physiotherapy treatment incorporated with chest physiotherapy. Chest physiotherapy techniques can be classified as conventional, modern, and instrumental techniques.
- Conventional: Conventional chest physiotherapy involves manual handling techniques to facilitate mucociliary clearance. It include postural drainage, percussion, vibration, huffing, coughing, and thoracic squeezing. It can be self administered or performed with the assistance of another person (a physiotherapist, parent, or caregiver).
- Modern: These techniques use variation of flow through breath control to mobilise secretions. It include forced expiration techniques, active cycle of breathing, autogenic drainage, assisted autogenic drainage, slow and prolonged expiration, increased expiratory flow, total slow expiration with the glottis open in a lateral posture, and inspiratory controlled flow exercises.
- Instrumental Techniques: It is used as adjunct. this include used of various instruments like flutter, incentive spirometry, Bubble PEP
Aim of Chest Physiotherapy
The purpose of chest physiotherapy are:
- To facilitate removal of retained or profuse airway secretions.
- To optimize lung compliance and prevent it from collapsing.
- To decrease the work of breathing.
- To optimize the ventilation-perfusion ratio/ improve gas exchange
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- Chaves GS, Freitas DA, Santino TA, Nogueira PA, Fregonezi GA, Mendonça KM. Chest physiotherapy for pneumonia in children. Cochrane Database of Systematic Reviews. 2019(1).
- Ebeledike C, Ahmad T. Pediatric Pneumonia. InStatPearls [Internet] 2020 Jan 6. StatPearls Publishing.
- Stuckey-Schrock K, Hayes BL, George CM. Community-acquired pneumonia in children. American family physician. 2012 Oct 1;86(7):661-7.
- World Health Organization. Revised WHO classification and treatment of pneumonia in children at health facilities: evidence summaries.2014
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