Respiratory physiotherapy is a technique primarily focused on developing, maintaining and restoring a person’s maximum respiratory amplitude and functional abilities.

First, the physiotherapist assesses the respiratory amplitude, then establishes a diagnosis. He will then plan the treatment, intervene manually and carry out a review to see the improvements. The objective is to allow the patient to recover enough lung capacity to perform the tasks of his daily life.

In recent years, scientific studies have demonstrated the effectiveness of ventilatory physiotherapy. In the form of physical exercises and manual manipulations, it is increasingly used in many fields, ranging from intensive care to chronic respiratory diseases.

• Maintain or improve exercise tolerance;
• Improve the performance of daily tasks;
• Maintain and improve physical activity, helping patients to adopt a leisure activity or an activity adapted to their capacities;
• Reduce shortness of breath;
• Improve the efficiency of ventilation;
• Support weaning from mechanical ventilation and implement normal non-invasive ventilation;
• Mobilize and help the expectoration of secretions (coughing up mucus);
• Improve patient knowledge and understanding;
• Reduce chest pain;
• Accompany the anxieties due to the lack of air and thus allow the patient to facilitate the work of breathing by expressing his fears.

In addition to manual manipulations, mechanical percussion can be used. Their purpose is to apply kinetic energy to the chest wall and lungs at regular intervals. Percussion is also called tapping, clapping or tapping. It can be performed by rhythmically striking the chest with one hand or by using a mechanical device applied directly to the affected lung segment (s). It allows the detachment and evacuation of mucus.

This technique is old and professionals no longer use it. “The clapping technique was taught 30 years ago when I was studying. Then it was criticized, deemed unnecessary, and even not recommended for respiratory diseases such as cystic fibrosis. I do not know what it is today, but I think it is a secondary technique with limited effectiveness.

The technique of choice is AFE (Acceleration of the expiratory flow). Pressures on the chest aim to lower the ribs to cause an exhalation. They are more or less strong and more or less rapid depending on the areas of the lungs that we are targeting.

Children can also cough and spit by putting pressure on the windpipe. “

Respiratory physiotherapist can be used at any age. It can be used on a premature baby, as well as on an elderly person. Children up to 2 to 3 years old have difficulty blowing their nose and coughing. This technique is useful for decluttering the bronchi.

The services of a physiotherapist can be used at all ages and at all stages of the disease, from early diagnosis, to acute episodes, to chronic illnesses and to hospital care.

Physiotherapists are part of the treatment path and the sessions are prescribed by the attending physician. Their role is clear: it includes assessment, counseling, education and treatment.

Traditionally, respiratory physiotherapists help mobilize and eliminate secretions. In patients with respiratory ailments, physiotherapy also aims to eliminate secretions.

Acute infantile bronchiolitis is a contagious viral infection that affects around 480 children each winter (Source: HAS). It affects the bronchioles (small bronchi) of infants and is characterized by an episode of respiratory discomfort, the signs of which are coughing and rapid, wheezing breathing. Often benign, its acute phase lasts an average of ten days and the first two days require increased attention from the infant.

Conventionally, the peak generally extends from November to the end of winter, causing a significant demand for consultation with general practitioners and an influx to emergency services – 2 to 3% of infants under 1 year would thus be hospitalized each year.

The pediatrician can prescribe, if he deems it necessary, respiratory physiotherapy sessions in order to facilitate the clearance of the bronchi and thus accelerate healing.

“To my knowledge”, specifies Jean-François Garreau, “there have never been scientific studies demonstrating the effectiveness of respiratory physiotherapy. Conversely, a medical study has shown that respiratory physiotherapy has no effect on healing bronchiolitis.

This is probably true, but in my opinion the question is whether one should blow one’s nose when one has a cold, knowing that this will not cure the cold in question.

Still, the doctors who often prescribe physiotherapy sessions for bronchiolitis hardly prescribe any more. It is also possible that cases are referred to specialized firms.

Personally, I only have 2 or 3 cases per winter. Respiratory physiotherapy was the only emergency we had. “

These sessions are therefore more often a privileged moment for parents who can express their concerns and make it possible to feel less helpless in the face of the crying of their infants. The professional will then have a posture of reassurance and education.

Although painless, a session can be overwhelming for parents. The child is lying on the consultation table and the professional exerts considerable pressure on the thorax, ensuring back and forth movements. The crying of the young child is then in no way caused by the pain, but rather by the discomfort that these gestures give him. Fortunately, the session does not last more than 15 minutes and the child immediately breathes better. For adults, the session lasts a little longer 20-30 minutes and the effectiveness is just as fast.

With the resurgence of interest in non-invasive ventilation techniques and greater sophistication in these techniques, physiotherapists have a greater arsenal to turn to. Many people with life-threatening respiratory failure can be managed successfully this way, by avoiding intubation. Likewise, carefully selected devices can help clear mucus.

The sessions are prescribed by the attending physician. The amount of fees per session is 17 € 20, 9 € 82 are reimbursed by health insurance (source : ameli.fr).