Prolonged slow expiration technique: has new chest physiotherapy a role in the treatment of bronchiolitis?

Bronchiolitis is an acute lower respiratory tract disease caused by a viral infection. It affects infants and often requires hospitalization. Treatment is based on supportive care1. Although all current guidelines do not recommend chest physiotherapy in the treatment of bronchiolitis, its role is still controversial and challenging 1,2. Two different respiratory physiotherapy techniques are known in the treatment of bronchiolitis: conventional Chest Physiotherapy (cCPT), which includes vibration, percussion, postural drainage and forced expiratory maneuvers, and new Chest Physiotherapy (nCPT), based on prolonged slow expiration techniques2. While most studies have demonstrated ineffectiveness and risk of associated adverse events for cCPT1, nCPT has showed some benefits improving bronchial airway obstruction and Wang score in hospitalized infants with bronchiolitis3. Nevertheless, lack of homogeneity of the studies in literature makes the interpretation of the results less reliable. Although nCPT seems to show fair results in terms of clinical effectiveness and safety, it is rarely used in the treatment of bronchiolitis. Further research is needed in order to enhance and confirm preliminary positive results of nCPT in the management of bronchiolitis.