Abstract

Pneumonia is one of the most common health problems affecting all age groups around the world. Chest physiotherapy includes a variety of techniques, such as conventional chest physiotherapy (i.e., percussion and postural drainage), active cycle of breathing techniques, positive expiratory pressure (using devices to maintain 10 to 25 cm of water pressure during expiration), and osteopathic manipulation. In theory, these techniques could help keep airways open, improve secretion clearance, and increase gas exchange. Chest physiotherapy has been widely used as an adjunctive therapy for pneumonia in adults without any reliable evidence. We evaluate the evidence examining the efficacy and safety of chest physiotherapy in adult patients with community-acquired pneumonia. Results: Six randomized controlled trials have assessed four types of chest physiotherapy, namely conventional chest physiotherapy, osteopathic manipulative treatment (including paraspinal inhibition, rib raising, and diaphragmatic or soft myofascial release), active cycle of breathing techniques (including active breathing control, thoracic expansion exercises andforced expiration technique) and positive expiratory pressure, in community-acquired pneumonia hospitalized patients. None of these techniques (versus no physiotherapy or placebo therapy) reduce mortality or improve cure rate. Limited evidence indicates that osteopathic manipulative treatment (versus placebo therapy) and positive expiratory pressure (versus no physiotherapy) can slightly reduce the duration of hospital stay (by 2.0 and 1.4 days, respectively). In addition, positive expiratory pressure (versus no physiotherapy) can slightly reduce the duration offever by 0.7 day, and osteopathic manipulative treatment (versus placebo therapy) might reduce the duration of antibiotic use by 1.93 days. No severe adverse events were reported. In summary, the available evidence is limited and chest physiotherapy should not be recommended as routine adjunctive treatment for non-complicated pneumonia in adults.