Immediate effects of a rhino-pharyngeal clearance protocol in nasal obstruction and middle ear condition of children under 3 years of age with upper respiratory infections: A randomized controlled trial / Efectos inmediatos de un protocolo de aclaramiento rinofaríngeo en la obstrucción nasal y el estado del oído medio en niños menores de 3 años con infecciones respiratorias superiores: un ensayo controlado aleatorizado

Introduction and objectives: Children up to 2 years old are at high risk of respiratory infections and nasal irrigation is often prescribed. Yet, to date there is no sufficient knowledge about its immediate effects on the nasopharynx and middle ear. Therefore, this study aimed to analyze the effect of a rhino-pharyngeal clearance intervention protocol on nasal obstruction and middle ear condition in children under 3 years of age with URTI. Materials and methods: Randomized controlled trial in a day-care centre of Porto, including 44 children randomized to Intervention Group (IG) and Control Group (CG). Nasal auscultation and tympanometry were performed at baseline (M0) as well as after the intervention (M1), which consisted of nasal irrigation (NaCl .9%) followed by a forced nasal inspiration in the IG, and after 30 min of normal activities, in the CG. Results: In M1 there was a lower frequency of children classified as having an obstructed nasal sound in the IG when compared to the CG (IG = 33.3%; CG = 68.4%; p = 0.042). We also observed an improvement of mean peak pressure (PP) in the IG (Left ear: M0 = -124daPa; M1 = -92daPa; p = 0.022. Right ear: M0 = -102daPa; M1 = -77daPa; p = 0.021), which was not observed in the CG (Left ear: M0 = -105daPa; M1 = -115daPa; p = 0.485. Right ear: M0 = -105daPa; M1 = -131daPa; p = 0.105). There were no significant results concerning the compliance of the tympanic membrane. Conclusions: The rhino-pharyngeal clearance improved the nasal obstruction and PP of the middle ear of children under 3 years of age with URTI

Introducción y objetivos: Los niños corren un alto riesgo de infecciones respiratorias superiores (IRS) y con frecuencia se prescriben irrigaciones nasales. Hasta hoy no hay suficiente conocimiento sobre sus efectos inmediatos en la nasofaringe y el oído medio. Por lo tanto, este estudio tuvo como objetivo analizar el efecto de un protocolo de intervención de limpieza nasal en la obstrucción y en el estado del oído medio de niños menores de 3 años con IRS. Material y métodos: Ensayo controlado aleatorizado en una guardería de Oporto, incluidos 44 niños asignados al Grupo de intervención (IG) y al Grupo de control (CG). La auscultación nasal y la timpanometría se realizaron al inicio (M0) y después de la intervención (M1), que consistió en irrigación nasal (NaCl 0,9%) seguido de una inspiración nasal forzada en IG, y después de 30 min de actividades normales en CG. Resultados: En M1 hubo una menor frecuencia de niños clasificados como con un sonido nasal obstruido en IG en comparación con CG (IG = 33,3%; CG = 68,4%; p = 0,042). También se observó una mejora de la presión máxima media (PP) en IG (oído izquierdo: M0 = -124daPa; M1 = -92daPa; p = 0,022; oído derecho: M0 = -102daPa; M1 = -77daPa; p = 0,021), que no se observó en CG (oído izquierdo: M0 = -105daPa; M1 = -115daPa; p = 0,485; oído derecho: M0 = -105daPa; M1 = -131daPa; p = 0,105). No hubo resultados significativos con respecto al cumplimiento de la membrana timpánica. Conclusiones: La limpieza nasal mejoró la obstrucción y la PP del oído medio de niños menores de 3 años con IRS

Immediate effects of a rhino-pharyngeal clearance protocol in nasal obstruction and middle ear condition of children under 3 years of age with upper respiratory infections: A randomized controlled trial.

INTRODUCTION AND OBJECTIVES: Children up to 2 years old are at high risk of respiratory infections and nasal irrigation is often prescribed. Yet, to date there is no sufficient knowledge about its immediate effects on the nasopharynx and middle ear. Therefore, this study aimed to analyze the effect of a rhino-pharyngeal clearance intervention protocol on nasal obstruction and middle ear condition in children under 3 years of age with URTI. MATERIALS AND METHODS: Randomized controlled trial in a day-care centre of Porto, including 44 children randomized to Intervention Group (IG) and Control Group (CG). Nasal auscultation and tympanometry were performed at baseline (M0) as well as after the intervention (M1), which consisted of nasal irrigation (NaCl .9%) followed by a forced nasal inspiration in the IG, and after 30min of normal activities, in the CG. RESULTS: In M1 there was a lower frequency of children classified as having an obstructed nasal sound in the IG when compared to the CG (IG=33.3%; CG=68.4%; p=0.042). We also observed an improvement of mean peak pressure (PP) in the IG (Left ear: M0=-124daPa; M1=-92daPa; p=0.022. Right ear: M0=-102daPa; M1=-77daPa; p=0.021), which was not observed in the CG (Left ear: M0=-105daPa; M1=-115daPa; p=0.485. Right ear: M0=-105daPa; M1=-131daPa; p=0.105). There were no significant results concerning the compliance of the tympanic membrane. CONCLUSIONS: The rhino-pharyngeal clearance improved the nasal obstruction and PP of the middle ear of children under 3 years of age with URTI.

Caregivers' education vs rhinopharyngeal clearance in children with upper respiratory infections: impact on children's health outcomes.

Upper Respiratory Tract Infections (URTI) are very common in children having no effective pharmacological treatment. This study aimed to compare the effect of caregivers' health education regarding children's respiratory infections and the effect of a rhinopharyngeal clearance protocol in children with URTI. A factorial trial was conducted in 138 children up to 3 years, attending day-care centres. Children were distributed into four groups: control group (CG) (n = 38); education group (EG) (n = 34); intervention group (IG) (n = 35); and education and intervention group (E + IG) (n = 31). A Diary of Records was kept by caregivers during 1 month. There were significant differences between groups concerning: Lower Respiratory Tract Infections (CG = 29.4%; EG = 10.7%; IG = 3.8%; E + IG = 0.0%; p = 0.014); acute otitis media (CG = 32.4%; EG = 7.1%; IG = 11.5%; E + IG = 7.7%; p = 0.014); medical consultations (CG = 70.6%; EG = 42.9%; IG = 38.5%; E + IG = 30.8%; p = 0.021); antibiotics (CG = 44.1%; EG = 7.1%; IG = 23.1%; E + IG = 15.4%; p = 0.006); days missed from day-care (CG = 55 days; EG = 22 days; IG = 14 days; E + IG = 6 days; p = 0.020); days missed from employment (CG = 31 days; EG = 20 days; IG = 5 days; E + IG = 1 day; p = 0.021); and nasal clearance techniques (CG = 41.4%; EG = 78.6%; IG = 57.7%; E + IG = 84.6%; p = 0.011). CONCLUSION: This study showed that the most positive impact on children's health outcomes occurred when combining health education of caregivers, regarding children's respiratory infections, with a rhinopharyngeal clearance protocol in children with URTI. What is Known: • Upper Respiratory Tract Infections are very common in children but still do not have an effective pharmacological treatment. • This generates a great burden of disease for the child and families, increasing the use of antibiotics. What is New: • This study is the first one that aims to analyze the effects of caregivers' health education in comparison to non-pharmacological intervention in acute respiratory infections in children. • It shows a positive impact on children's health outcomes, empowering caregivers regarding their child's health and reducing the burden of disease, medical consultations and the use of antibiotics.

Subjective and objective parameters in paediatric respiratory conditions: cultural adaptation to Portuguese population / Parâmetros anamnésicos e semiológicos em condições respiratórias pediátricas: adaptação cultural para a população portuguesa

Abstract Introduction: Young children are at high risk of respiratory infections. The severity of the disease is based on the assessment of signs and symptoms, although there is a lack of validated scales to the Portuguese population. Objective: The aim of this study was to accomplish the cultural adaptation and validation of the subjective and objective parameters in paediatric respiratory conditions, according to Postiaux. Methods: We ensured the cultural adaptation of the "Paramètres anamnestiques et cliniques utiles au suivi et à l'achèvement de la toilette bronchopulmonaire du nourrisson et de l'enfant", created by Guy Postiaux. Then we analysed content, conceptual and construct validity, as well as test-retest reliability. The Portuguese version was applied in a sample of 59 children, with a mean age of 23.05 ± 8.34 months, 55.9% male. Results: We stablished semantics and construct validity and adopted the title "Paediatric Respiratory Severity Score" (PRSS). PRSS obtained a good internal consistency (α de Cronbach = 0.80) and an excellent intra-rater reliability (ICC = 0.91). Subjective parameters revealed a Cronbach' α = 0.80 and an ICC = 0.90. Objective parameters obtained a Cronbach' α = 0.73 and an ICC = 0.85. The application of PRSS to the sample showed that 37.3% of the children had a normal health condition (PRSS = 8) and 62.7% of the children had a moderate impairment of their health condition (9 ≤ PRSS ≤ 16). Conclusion: Paediatric Respiratory Severity Score is a valid and reliable measure to assess the severity of acute respiratory infections in children under 36 months of age.

Resumo Introdução: As crianças pequenas são uma população de risco para infeções respiratórias, cuja severidade é estabelecida através da avaliação de sinais e sintomas. Há contudo poucas escalas validadas para a população portuguesa. Objetivo: O nosso objetivo foi realizar a adaptação cultural e validação dos parâmetros anamnésicos e semiológicos em condições respiratórias pediátricas, segundo Postiaux. Métodos: Procedemos à adaptação cultural de "Paramètres anamnestiques et cliniques utiles au suivi et à l'achèvement de la toilette bronchopulmonaire du nourrisson et de l'enfant", criada por Guy Postiaux. Seguidamente avaliamos as equivalências semântica, de conteúdo, conceptual e de construção e a confiabilidade teste reteste. A escala foi posteriormente aplicada numa amostra de 59 crianças, com média de idades de 23,05 ± 8,34 meses, 55,9% do sexo masculino. Resultados: As equivalências semântica e de conteúdo foram verificadas, sendo atribuído o título de Escala de Severidade Respiratória Pediátrica (ESRP). Realizou-se ainda a equivalência de construção (α de Cronbach = 0,80) e a confiabilidade teste reteste (ICC = 0,91). A análise dos parâmetros anamnésicos revelou um α de Cronbach = 0,80 e um ICC = 0,90. A análise dos parâmetros semiológicos mostrou um α de Cronbach = 0,73 e um ICC = 0,85. A aplicação da ESRP à amostra revelou que 37,3% crianças apresentaram um índice de severidade normal (ESRP=8) e 62,71% um índice moderado (9 ≤ ESRP ≤ 16). Conclusão: A ESRP é uma medida válida e confiável para avaliação dos sinais e sintomas de infeção respiratória.

Chest physical therapy in acute viral bronchiolitis: an updated review.

We describe the various therapies for infant acute viral bronchiolitis and the contradictory results obtained with chest physical therapy. The treatment target is bronchial obstruction, which is a multifactorial phenomenon that includes edema, bronchoconstriction, and increased mucus production, with a clinical grading defined as severe, moderate, or mild. Chest physical therapy is revisited in its various modalities, according to preliminary scoring of the disease.

Chest physical therapy is effective in reducing the clinical score in bronchiolitis: randomized controlled trial / A fisioterapia respiratória é eficaz na redução de escore clínico na bronquiolite: ensaio controlado randomizado

OBJECTIVE: To evaluate the effectiveness of chest physical therapy (CP) in reducing the clinical score in infants with acute viral bronchiolitis (AVB). METHODS: Randomized controlled trial of 30 previously healthy infants (mean age 4.08 SD 3.0 months) with AVB and positive for respiratory syncytial virus (RSV), evaluated at three moments: at admission, then at 48 and 72 hours after admission. The procedures were conducted by blinded assessors to each of three groups: G1 - new Chest Physical therapy- nCPT (Prolonged slow expiration - PSE and Clearance rhinopharyngeal retrograde - CRR), G2 - conventional Chest Physical therapy- cCPT (modified postural drainage, expiratory compression, vibration and percussion) and G3 - aspiration of the upper airways. The outcomes of interest were the Wang's clinical score (CS) and its components: Retractions (RE), Respiratory Rate (RR), Wheezing (WH) and General Conditions (GC). RESULTS: The CS on admission was reduced in G1 (7.0-4.0) and G2 (7.5-5.5) but was unchanged in G3 (7.5-7.0). We observed a change 48 hours after hospitalization in G1 (5.5-3.0) and G2 (4.0-2.0) and in 72 hours, there was a change in G1 (2.0-1.0). CONCLUSION: The CP was effective in reducing the CS in infants with AVB compared with upper airway suction only. After 48 hours of admission, both techniques were effective and nCPT techniques were also effective in the 72 hours after hospitalization compared with cCPT techniques.

OBJETIVO: Avaliar a efetividade da fisioterapia respiratória na redução do escore clínico em lactentes com bronquiolite viral aguda (BVA). MÉTODOS: Ensaio controlado randomizado de 30 lactentes (média de idade 4,08±3,12 meses) com BVA, previamente hígidos, com vírus sincicial respiratório (VSR) positivo, avaliados em três momentos: admissão, 48 e 72 horas, antes e após os procedimentos por avaliadores cegos, em três grupos: G1 - técnicas atuais de fisioterapia (expiração lenta e prolongada e desobstrução rinofaríngea retrógrada), G2 - técnicas convencionais de fisioterapia (drenagem postural modificada, compressão expiratória, vibração e percussão) e G3 - aspiração de vias aéreas superiores por meio do escore clínico de Wang e seus componentes: retrações (RE), frequência respiratória (RR), sibilos (WH) e condições gerais (GC). RESULTADOS: O escore clínico de Wang (CS) no momento admissão, no G1, reduziu de 7,0-4,0; no G2, de 7,5-5,5 e no G3 de 7,5-7,0, não apresentando alteração. No momento 48 horas, também houve alteração tanto no G1 (5,5-3,0) quanto no G2 (4,0-2,0) e, em 72 horas, apenas no G1 (2,0-1,0). CONCLUSÃO: A fisioterapia respiratória foi efetiva na redução do escore clínico em lactentes com BVA quando comparada com a aspiração isolada das vias aéreas na admissão. No momento 48 horas, ambas as técnicas foram efetivas, sendo que as técnicas atuais foram efetivas também nas 72 horas após a internação, comparada às técnicas convencionais.

Chest physical therapy is effective in reducing the clinical score in bronchiolitis: randomized controlled trial.

OBJECTIVE: To evaluate the effectiveness of chest physical therapy (CP) in reducing the clinical score in infants with acute viral bronchiolitis (AVB). METHODS: Randomized controlled trial of 30 previously healthy infants (mean age 4.08 SD 3.0 months) with AVB and positive for respiratory syncytial virus (RSV), evaluated at three moments: at admission, then at 48 and 72 hours after admission. The procedures were conducted by blinded assessors to each of three groups: G1 - new Chest Physical therapy- nCPT (Prolonged slow expiration - PSE and Clearance rhinopharyngeal retrograde - CRR), G2 - conventional Chest Physical therapy- cCPT (modified postural drainage, expiratory compression, vibration and percussion) and G3 - aspiration of the upper airways. The outcomes of interest were the Wang's clinical score (CS) and its components: Retractions (RE), Respiratory Rate (RR), Wheezing (WH) and General Conditions (GC). RESULTS: The CS on admission was reduced in G1 (7.0-4.0) and G2 (7.5-5.5) but was unchanged in G3 (7.5-7.0). We observed a change 48 hours after hospitalization in G1 (5.5-3.0) and G2 (4.0-2.0) and in 72 hours, there was a change in G1 (2.0-1.0). CONCLUSION: The CP was effective in reducing the CS in infants with AVB compared with upper airway suction only. After 48 hours of admission, both techniques were effective and nCPT techniques were also effective in the 72 hours after hospitalization compared with cCPT techniques.

Prolonged slow expiration technique in infants: effects on tidal volume, peak expiratory flow, and expiratory reserve volume.

BACKGROUND: Prolonged slow expiration (PSE) is a physiotherapy technique often applied in infants to reduce pulmonary obstruction and clear secretions, but there have been few studies of PSE's effects on the respiratory system. OBJECTIVE: To describe PSE's effects on respiratory mechanics in infants. METHODS: We conducted a cross-sectional study with 18 infants who had histories of recurrent wheezing. The infants were sedated for lung-function testing, which was followed by PSE. The PSE consisted of 3 sequences of prolonged manual thoraco-abdominal compressions during the expiratory phase. We measured peak expiratory flow (PEF), tidal volume (V(T)), and the frequency of sighs during and immediately after PSE. We described the exhaled volume during PSE as a fraction of expiratory reserve volume (%ERV). We quantified ERV with the raised-volume rapid-thoracic-compression technique. RESULTS: The cohort's mean age was 32.2 weeks, and they had an average of 4.8 previous wheezing episodes. During PSE there was significant V(T) reduction (80 ± 17 mL vs 49 ± 11 mL, P < .001), no significant change in PEF (149 ± 32 mL/s vs 150 ± 32 mL/s, P = .54), and more frequent sighs (40% vs 5%, P = .03), compared to immediately after PSE. The exhaled volume increased in each PSE sequence (32 ± 18% of ERV, 41 ± 24% of ERV, and 53 ± 20% of ERV, P = .03). CONCLUSIONS: It was possible to confirm and quantify that PSE deflates the lung to ERV. PSE caused no changes in PEF, induced sigh breaths, and decreased V(T), which is probably the main mechanical feature for mucus clearance.

Evaluation of an alternative chest physiotherapy method in infants with respiratory syncytial virus bronchiolitis.

BACKGROUND: We proposed a new chest physiotherapy (CPT) secretion clearance method to treat respiratory syncytial virus bronchiolitis in infants. Our new CPT method consists of 15 prolonged slow expirations, then 5 provoked cough maneuvers. METHODS: We randomized 20 infants (mean age 4.2 months) into 2 groups: 8 patients received 27 sessions of nebulization of hypertonic saline; 12 patients received 31 sessions of nebulization of hypertonic saline followed by our new CPT method. We used the Wang clinical severity scoring system (which assesses wheezing, respiratory rate, retractions, and general condition) and measured S(pO(2)) and heart rate before each CPT session (T0), immediately after the 30-min session (T30), and 120 min after the session (T150). RESULTS: Within the groups: in the first group, Wang score was significantly lower at T150 than at T0: 4.6 vs 5.0 (P = .008). In the new-method-CPT group, Wang score was significantly lower at T30 (3.6 vs 4.3, P = .001) and at T150 (3.7 vs 4.3, P = .002). Wheezing score was significantly lower at T150 than at T0 (1.1 vs 1.2, P = .02) in the first group, and in the new-method-CPT group at T30 than at T0 (0.8 vs 1.3, P = .001) and at T150 than at T0 (0.9 vs 1.3, P = .001). Between the groups: at T30 the improvement was significantly better in the new-method-CPT group for overall Wang score (P = .02), retractions (P = .05), respiratory rate (P = .001), and heart rate (P < .001). At T150 the Wang score was not significantly different between the groups. At T30 (versus T0) the difference in percent gain between the groups was significant for Wang score (P = .004), wheezing (P = .001), and heart rate (P = .02). Over 5-hospital days, the daily baseline (T0) Wang score decreased significantly in the new-method-CPT group (P = .002), whereas it did not in the first group. There were no adverse events. Average hospital stay was not significantly different between the groups. CONCLUSIONS: Our new CPT method showed short-term benefits to some respiratory symptoms of bronchial obstruction in infants with acute respiratory syncytial virus bronchiolitis.