When I’ve kept saying for years that this barbaric technique has only contributed to develop permanent breathing problems to children - most of the time leading to asthma - I am told to be crazy within this sector which exploits this commercial niche. When no fracture nor child abuse were reported by the Health & Social Services, the baby’s ribcage ends up to be totally unstructured, with 8 to 10 chondro-costal subluxations.

A couple of days ago, I received a letter from a mother whom I’ll not name :

I’ve just watched your website and I found it very interesting.
My son, Gaspard, 2, had about 150 respiratory physiotherapy sessions because of recurrent bronchitis.
When he was 12 months, the lung specialist prescribed him the whole range of traditional drugs for asthma (flixotide, ventoline, aérius and singulair), with no result.
Homeopathy worked out well during 6 months, but since he went back to school, the bronchitis started again. He has now to take Augmentin, but after 4 days without, cough is back.
Physio sessions help him to cough up the congested mucous, but it is endless.
He suffers from a bronchial hyperreactivity.
Nights are bad and medical treatments inefficient.
Doctors stubbornly prescribe their asthma treatment.
What can we do ?

That record was broken : one of my practitioners treated a child who got more than 250 respiratory physiotherapy sessions !
How is it possible that our social welfare accepts to pay for so many sessions ?
A previous enquiry published in the magazine "Prescrire" the uselessness of Ventoline in the bronchiolitis for infants !
This respiratory physiotherapy technique is used only in the French speaking countries, and it is even forbidden in some other countries !
So, Parents, think carefully about this before turning systematically to the respiratory physiotherapy when your child has a bronchitis !

Here is a study taken from the website "PLoS Medicine" a peer-reviewed open-access journal publisched by The Public Library of Science which demonstrates the uselessness of chest physiotherapy by increasing the breathing passages commonly practiced in the French speaking countries.

Jacques Gesret

Editors’ Summary of this study

Background. Bronchiolitis, which is usually caused by the respiratory syncytial virus (RSV), is the commonest infection of the lower respiratory tract (the lungs and the passages through which air enters the lungs) in infants. A third of all children have bronchiolitis during their first year of life. The illness begins with stuffiness, a runny nose, a mild cough, and mild fever. Then, as the smallest airways in the lung (the bronchioles) become inflamed (swell) and blocked with mucus, the cough worsens, and the infant may develop a wheeze, shallow breathing, and a rapid heartbeat. Most cases of bronchiolitis are mild and clear up within two weeks without any treatment but some infants develop severe disease. Such infants struggle to get enough air into their lungs, drawing in their chest with each breath (chest recession). They have trouble eating and drinking, and the oxygen level in their blood can drop dangerously low. About 1% of previously healthy infants need hospitalization because of severe bronchiolitis. These severely affected infants are not normally given any medications but, where necessary, they are given oxygen therapy, fed through a tube into their stomach, and given fluids through a vein.

Why Was This Study Done? In some countries, chest physiotherapy is routinely given to infants with bronchiolitis even though this is not a recommended treatment internationally. In France, for example, virtually all outpatients with bronchiolitis receive a form of chest physiotherapy known as increased exhalation technique with assisted cough (IET + AC). IET(a manual chest compression)is designed to clear mucus from the bronchioles whereas AC (coughing triggered by applying pressure to the top of the breastbone) facilitates clearance of the large airways. But is IET + AC an effective treatment for bronchiolitis? In this study, the researchers undertook a multicenter, randomized, controlled trial to answer this question. A randomized trial is a study in which patients are randomly allocated to receive either the treatment under study or a control treatment. Usually in such trials, noone is aware of the treatment allocations until the trial has been completed. This is called blinding and avoids unconscious biases being introduced into the results. In this trial, although the parents,caregivers, and outcome assessors were blinded, the physiotherapists and the infants were aware of treatment allocations. The physiotherapists were not involved in patient assessment, however, and the infants were sufficiently young that their knowledge of their treatment was unlikely to bias the results.

What Did the Researchers Do and Find? The researchers enrolled nearly 500 children aged 15 days to 2 years who were admitted to seven French hospitals for a first episode of acute bronchiolitis. They randomly allocated the patients to receive IET + AC (intervention group) or nasal suction (control group) three times a day from a physiotherapist working alone in a room with blacked-out windows. The primary outcome of the trial was the patients’ time to recovery. Infants were judged to have recovered if they had not had oxygen therapy or showed signs of chest recession for 8 hours and had ingested more than two-thirds of their daily food requirement. Infants in the control group took an average of 2.31 days to recover whereas those in the intervention group took 2.02 days. However, this difference in recovery time was not statistically significant. That is, it could have happened by chance. The researchers also recorded several secondary outcomes such as admission to an intensive care unit, help with breathing, antibiotic treatment, and parental perceptions of their child’s comfort. There were no significant differences between the two treatment groups for any of these secondary outcomes, although the parents did report that the IET + AC treatment was harder on their children than nasal suction while not reducing their overall comfort.

What Do These Findings Mean? These findings show that chest physiotherapy (IET + AC) had no significant effect on the time to recovery of a large population of French infants admitted to hospital with severe bronchiolitis. These results cannot be extrapolated, however, to infants with mild or moderate bronchiolitis, and further studies are needed to assess whether chest physiotherapy is of any benefit in an outpatient setting. Three small trials of a different form of chest physiotherapy have also previously failed to find any effect of chest physiotherapy on recovery time. Thus, none of the currently available results support the routine use of chest physiotherapy in infants admitted to a hospital for severe bronchiolitis.

Abstract

Background: Acute bronchiolitis treatment in children and infants is largely supportive, but chest physiotherapy is routinely performed in some countries. In France, national guidelines recommend a specific type of physiotherapy combining the increased exhalation technique (IET) and assisted cough (AC). Our objective was to evaluate the efficacy of chest physiotherapy (IET + AC) in previously healthy infants hospitalized for a first episode of acute bronchiolitis.

Methods and Findings: We conducted a multicenter, randomized, outcome assessor-blind and parent-blind trial in seven French pediatric departments. We recruited 496 infants hospitalized for first-episode acute bronchiolitis between October 2004 and January 2008. Patients were randomly allocated to receive from physiotherapists three times a day, either IET + AC (intervention group, n = 246) or nasal suction (NS, control group, n = 250). Only physiotherapists were aware of the allocation group of the infant. The primary outcome was time to recovery, defined as 8 hours without oxygen supplementation associated with minimal or no chest recession, and ingesting more than two-thirds of daily food requirements. Secondary outcomes were intensive care unit admissions, artificial ventilation, antibiotic treatment, description of side effects during procedures, and parental perception of comfort. Statistical analysis was performed on an intent-to-treat basis. Median time to recovery was 2.31 days, (95% confidence interval [CI] 1.97–2.73) for the control group and 2.02 days (95% CI 1.96–2.34) for the intervention group, indicating no significant effect of physiotherapy (hazard ratio = 1.09, 95% CI 0.91–1.31, p = 0.33). No treatment by age interaction was found (p = 0.97). Frequency of vomiting and transient respiratory destabilization was higher in the IET + AC group during the procedure (relative risk [RR] = 10.2, 95% CI 1.3–78.8, p = 0.005 and RR = 5.4, 95% CI 1.6–18.4, p = 0.002, respectively). No difference between groups in bradycardia with or without desaturation (RR = 1.0, 95% CI 0.2–5.0, p = 1.00 and RR = 3.6, 95% CI 0.7–16.9, p = 0.10, respectively) was found during the procedure. Parents reported that the procedure was more arduous in the group treated with IET (mean difference = 0.88, 95% CI 0.33–1.44, p = 0.002), whereas there was no difference regarding the assessment of the child's comfort between both groups (mean difference = −0.07, 95% CI −0.53 to 0.38, p = 0.40). No evidence of differences between groups in intensive care admission (RR = 0.7, 95% CI 0.3–1.8, p = 0.62), ventilatory support (RR = 2.5, 95% CI 0.5–13.0, p = 0.29), and antibiotic treatment (RR = 1.0, 95% CI 0.7–1.3, p = 1.00) was observed.

Conclusions
Chest physiotherapy (IET + AC) had no significant effect on time to recovery in this group of hospitalized infants with bronchiolitis.

Additional studies are required to explore the effect of chest physiotherapy on ambulatory populations and for infants without a history of atopy.

[www.ncbi.nlm.nih.gov]

Advantages of the Chest physiotherapy:
The child is free from his mucus and his breathing is better.

Drawbacks of the Chest physiotherapy:
Causes a lot of chondrocostal subluxations.

Consequences:
It was demonstrated that asthma (true asthma) was due to chondrocostal subluxations:
- First rib: allergies
- First and second rib: Exercise induced asthma
- First and third rib: Bronchial asthma
- First and fourth rib: Cardiac asthma

Observations:
For years now I found that children who have had a lot of chest physiotherapy are the ones who have more crises and need more emergency hospitalization. These children have usually between 8 and 10 subluxation (T1 to T5). These subluxations are responsible of messages which are interpreted as messages coming from the plexus (bronchial tubes and lungs). This results in inflammatory responses with mucus production.

What shall we do?
If it is necessary to use chest physiotherapy for babies or children, the ribs should be re-settled after each session or one must find a technique other than a powerful front chest support.

Look at the practitioner’s left hand on these videos (If you are sensitive do not watch them.)

[asthma-reality.com]
[asthma-reality.com]

You will understand why most of the subluxations are located on right side of the thorax.
You can also notice that the practitioner does not wear coat and gloves.

Jacques Gesret

Rib fractures after chest physiotherapy for bronchiolitis or pneumonia in infants:
Articles published in Pediatr Radiol in 2002
[www.springerlink.com]

Abstract Background: The reported causes of rib fractures in infants are: child abuse, accidental injury, cardiopulmonary resuscitation, bone fragility, birth trauma and severe cough.
Objective: To report chest physiotherapy (CPT) as a new cause of rib fractures in five infants.
Materials and methods: We retrospectively identified all infants with rib fractures after CPT for bronchiolitis or pneumonia over a 4-year period in two paediatric and one paediatric radiology units in three university hospitals in Paris.
Results: Five boys were identified. Their median age was 3 months. None had any other potential cause of rib fractures. The indication for CPT was bronchiolitis in four cases and pneumonia in one. The median number of rib fractures was four (range 1–5). Fractures were located between the 3rd and 8th ribs; they were lateral in four patients and posterior in one; they were unilateral in four patients and bilateral in one. Evolution was favourable in all cases. The prevalence of rib fractures after CPT during the study period was estimated at 1 in 1,000 infants hospitalised for bronchiolitis or pneumonia.
Conclusions: CPT should be considered a potential, but very rare cause of rib fractures in infants. It can be of clinical relevance when rib fractures are the only feature suggestive of child abuse.

Evaluation of the forced expiration technique as an adjunct to postural drainage in treatment of cystic fibrosis:
BRITISH MEDICAL JOURNAL 18 AUGUST 1979
[www.bmj.com]

Summary and conclusions: Sixteen patients with cystic fibrosis were treated with conventional physiotherapy aided by an assistant. The results were compared with those produced by pysiotherapy using the forced expiration technique without an assistant. The forced expiration technique cleared more sputum in less time than conventional physiotherapy. A second study showed that an assistant did not further improve the results obtained by the patient performing the forced expiration technique himself. These findings mean that patients with cystic fibrosis who have had to rely on the help of others for their home treatment may now perform more effective treatment without help. The forced expiration technique might also be helpful for patients with chronic bronchitis, asthma, or bronchiectasis.

Jacques Gesret