COPD: chest physiotherapy increases sputum production without improving pulmonary function

Clinical bottom line (level 1a-)

Bronchopulmonary hygience physical therapy improves sputum production in patients with COPD or bronchiectasis, but there is no improvement in pulmonary function.

Jones and Rowe: Cochrane Library 1998; 3 : -

Expires October 2003

The study

Systematic review of all randomised controlled trials of

Patients: COPD or bronchiectasis

Intervention: bronchopulmonary hygiene physical therapy (including chest percuession and postural drainage to remove lung secretions, vibration, directed coughing or forced exhalation) compared with other techniques, placebo or no treatment

Outcome: pulmonary function, death, length of hospital stay, adverse effects

Articles found in ?all languages using Cochrane Airway Review Group register, - (search terms: postural drainage or physical therapy or percussion or physiotherapy ) and seraching reference lists of selected studies and review articles. Authors were contacted to verify data and search for unpublished studies.

Selection criteria: see above
Appraisal criteria: 2 independent blinded reviewers: using Jada 5 point scoring system
Articles excluded if:

7 studies involving 126 patients: 6 comparisons were performed. 1 in acute COPD exacerbation; 2 chronic COPD; 2 bronchiectasis; 2 comparing manual and mechanical techniques.

Results could not be combined because studies addressed different patient groups and outcomes.

The evidence

Physical therapy had no effect on pulmonary function in acute COPD exacerbations.
Physical therapy increased sputum production in chronic COPD, but had no effect on pulmonary function.
Physical therapy increased sputum production in bronchiectasis.

Comments

Studies were universally small with methodological flaws.

Citation

Jones AP, and Rowe BH: bronchopulmonary hygience physical therapy for chronic obstructive pulmonary disease and bronchiectasis (Cochrane Review). Cochrane Library 1998; 3 : -

Search Terms: COPD in Cochrane Library
Contributor: Chris Ball, October 2001
Reviewer:

_{Clinical Question.}

_Patient	_{COPD or bronchiectasis}
_{Intervention or Exposure}	_{bronchopulmonary hygience physical therapy, chest physiotherapy}
_Outcome	_{sputum production, improvement in pulmonary function}