Community-acquired pneumonia: bottle blowing reduced the duration of fever and hospital stay

Clinical bottom line (level 1b)

  1. Patients with community-acquired pneumonia who performed bottle blowing hourly had a shorter duration of fever than patients who just coughed (on average by half a day).
  2. Patients who performed bottle blowing therapy spent less time in hospital (on average 1.5 days fewer).
  3. There is no clear difference in fever duration or hospital stay between patients who took deep breaths daily and those who coughed.
Bjorkqvist et al: Scandinavian Journal of Infectious Diseases 1997; 29 : 77-82
Expires June 2004

The study

Unblinded ?concealed randomised trial with intention-to-treat
Setting: general hospital, Sweden

145 patients (aged range 16 to 95 years; mean 65, 58% male) with untreated community-acquired pneumonia (diagnosed on chest X-ray) who were admitted to hospital on Monday to Thursdays

Excluded if
  • admitted over the weekend
  • already taking antibiotics
  • unable to blow into vitalograph because of fatigue or dementia
  • in need of traditional chest physiotherapy or bottle blowing because of profuse respiratory secretions and inability to expectorate
  • pronounced obstructive symptoms and in need of intravenous asthma therapy
  • declined participation
  • already included from previous admission
  • physiotherapist not on duty or patient not reported to her
  • various other reasons such as not living in the area, drug abuse and HIV positivity

Control Group: (n = 48, 40 analysed): Early mobilisation and instructed in the technique of coughing by 'huffing'
Experimental Group: (n = 47, 38 analysed): Given coughing instructions as group A and instructed to sit up with their feet on the floor and take 10 deep breaths and after a short break another 10 breaths on one occasion every hour in the daytime between 9am and 8pm, except for breaks at meals at noon and 5pm
Experimental Group: (n = 50, 48 analysed): Instructed in coughing as group A and were given a bottle containing 10 cm of tap water and asked to sit up with their feet on the floor and blow bubbles at a calm speed into the bottle through a plastic tube (10 mm in diameter) with an air pressure just sufficient to overcome the resistance of the water. This was done 20 times with a rest after 10, every hour from 9am to 8pm with breaks at noon and 5pm. After discharge they continued 2 times 10 breaths on 5 occasions each day for 14 days.

97% followed for 5 weeks

The evidence

Outcome Control Group
(SD)		 Experimental Group
(SD)		 Mean Difference
(95% CI)
mean days of fever (control versus deep breaths) 2.3
(2.1) 		1.7
(1.2) 		0.6
(-0.1 to 1.3)
mean duration of fever (control versus bottle blowing) 2.3
(2.1) 		1.6
(1.0) 		0.7
(0.05 to 1.4)
mean duration of hospital stay (control versus deep breaths) 5.3
(3.9) 		4.6
(3.3) 		0.7
(-0.8 to 2.2)
mean duration of hospital stay (control versus bottle blowing) 5.3
(3.9) 		3.9
(2.9) 		1.4
(0.03 to 2.8)

Comments

  1. Control patients had on average 2.3 days of fever, and spent 5.3 days in hospital.

Citation

  1. Bjorkqvist M, Wiberg B, Bodin L, et al: bottle-blowing in hospital-treated patients with community-acquired pneumonia. Scandinavian Journal of Infectious Diseases 1997; 29 : 77-82
Contributor: Clare Wotton, December 1999
Reviewer: Chris Ball

Clinical Question.
Patient community-acquired pneumonia
Intervention or Exposure bottle blowing or deep breaths
Comparison early mobilsation
Outcome fever duration and hospital stay