Finding the right solution for a patient’s specific problem—taking all factors into account—is always a challenge. However, with a well-individualized treatment plan, respiratory conditions can be resolved more effectively and quickly. Following this refresher course, we hope to be even better equipped to design and implement effective treatment plans for our patients.
Continuing education in Physiotherapy for respiratory infections
At the start of the new year, we wish everyone the very best, that dreams may come true and that everyone may enjoy good health.
After the Christmas holidays, the children returned to school with enthusiasm, but many quickly came home with respiratory infections. We are now regularly receiving new referrals of children with respiratory conditions at our practice. To prepare for this, we attended a refresher course on respiratory physiotherapy in children at the start of the RSV season. Two of our physiotherapists traveled to Brussels on a Saturday morning in November for the training “Wheezing, Whistling, Struggling: From RSV Bronchiolitis to Necrotizing Pneumonia” at the VUB. We were eager to learn what new insights we could gain for the physiotherapeutic treatment of our patients.
The first session was led by Prof. Dr. De Wachter, who spoke about the pathology, complications and medical treatment. She had also observed a sharp increase in pediatric patients in recent weeks. Respiratory diseases are very common in young children under the age five years old, with a peak under the age of two due to the immaturity of the immune system. An typical 'healthy child' experiences around 6 to 8 infections per year, mostly upper respiratory tract infections. Factors that can increase frequency include passive smoking, low birth weight, staying at a daycare, low socio-economic status, prematurity or dysmaturity, and underlying medical conditions. In the case of respiratory infections, a good diagnosis can sometimes be a challenge, but it is essential for starting appropriate treatment. If the therapy for a diagnosis does not help, it is important to check whether the medication is being taken correctly and whether the diagnosis is accurate.
Viral bronchiolitis, the most common respiratory infection in infants, is often caused by RSV (Respiratory Syncytial Virus). This virus spreads through inhaling of small infected droplets of saliva, after which fever and runny nose appear withing 4 to 6 days, indicating an upper respiratory infection. Cells in the nose are damaged and start to peel, these are inhaled and spread further to the lower airways or bronchioles. A couple of days later the child will begin coughing, indicating a lower respiratory infection. On average, symptoms last about two weeks before the child fully recovers. Depending on severity, the child may recover at home or requires hospitalization. Alarming signs of a severe condition include apathy, decreased oxygen saturation, and poor appetite.
The guidelines for the treatment of bronchiolitis according to the National Institute for Health and Care Excellence and the American Academy of Pediatrics are as follows:
- educating parents about the cause, diagnosis, progression and treatment
- avoiding cigarette smoke
- ensuring adequate fluid or food intake
- nasal rinses
- administering oxygen to maintain saturation above 92%
- if necessary high-flow oxygen or additional support
- respiratory physiotherapy in case of atelectasis (complete collapse of the bronchioles due to mucus obstruction)
In our practice, we can provide added value for children infected with RSV by educating parents about the course of the illness and supporting factors or risk factors for severe progression. We can also teach parents how to rinse the child's nose correctly and efficiently, and provide respiratory physiotherapy in he event the small airways are completely blocked.
The next topic covered was pneumonia acquired outside the hospital (CAP). This remains the leading cause of morbidity and mortality in children worldwide. There has been a strong improvement since the 1980s due to better hygiene and antibiotic use, but it still occurs regularly in our country. The clinical presentation varies depending on bacterial or viral causes. In young children, symptoms often start with a cold, followed by fever and general malaise. Dyspnea, nasal flaring, intercostal retractions, absence of cough, abdominal pain (in lower lobe pneumonia), and oxygen deprivation may also occur. Treatment consists of oxygen if needed, aerosol therapy (for asthma only), antibiotics (for bacterial pneumonia), and physiotherapy if a bronchial component is present. With proper treatment, clear improvement is usually seen within 48–72 hours.
After the break, Prof. Dr. Ernst explained medical imaging for acute respiratory conditions. We gained better insight into evaluating X-rays and identifying different structures of the lungs on chest radiographs. Imaging is highly valuable for diagnosing and monitoring acute lower respiratory infections. After just half an hour, we could already recognize differences in imaging between conditions such as bronchitis, bronchiolitis, atelectasis, bronchopneumonia, and pneumonia, though interpretation still relies heavily on expert radiologists. In private physiotherapy practices, we rarely see X-rays directly but do receive the explanatory report, which helps us plan and evaluate treatment.
The final speaker was Filip Van Ginderdeuren, PT, MSc, PdD, a physiotherapist at UZ Brussel - VUB. He provided an overview of the scientific literature regarding physiotherapy for acute respiratory infections. Based on several studies, there is hope that techniques such as assisted autogenic drainage may offer greater benefits than traditional methods such as tapping and postural drainage, though further research is needed to substantiate this. The techniques physiotherapists can apply were discussed according to the patient and diagnosis. Devices that can support treatment, such as PEP, Flutter, IPV, and bottle-blowing exercises, were reviewed. These techniques and devices were also considered in several case studies.
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