ABSTRACT
This article reports an exchange of unbiased arguments between Mr Guy Postiaux speaking in favour of respiratory physiotherapy in acute viral bronchiolitis in the newborn and Prof. Jean-Christoph Dubus arguing against. A review of the literature suggests that traditional methods of physiotherapy should be abandoned because they are not validated and because they have harmful side effects. The latest Cochrane revue (2016) suggests the use of slow expiration techniques that have some validated elements and cause no harmful side effects. Large multicentre studies should be undertaken to confirm or refute the results of the five studies in the Cochrane review. Their analysis would allow extraction of objective evidence for the efficacy of slow expiration techniques on the relief of bronchopulmonary obstruction and the reduction of the degree of severity in the short and medium term. Studies of the effect of ambulatory respiratory physiotherapy for bronchiolitis of a moderate degree not requiring hospitalisation are not available. An evaluation is needed which is based on the pathophysiology of multifactorial bronchial obstruction and on the physical signs, of which auscultation is the cornerstone.
Subject(s)
Bronchiolitis, Viral/therapy , Physical Therapy Modalities , Respiratory Therapy/methods , Acute Disease , Humans , Infant, Newborn , Physical Therapy Modalities/adverse effects , Respiratory Therapy/adverse effectsABSTRACT
INTRODUCTION: The overall duration of a pulmonary crackle is usually less than 20-30 ms but psychoacoustics demonstrates that an acoustical event with a duration of less than 20-40 ms cannot be estimated in terms of pitch and duration. We pose the hypothesis that the main resonant information is contained into the breath sounds following the crackle. METHODS: Eight patients with COPD, viral pneumonia, bronchiectasis, congestive heart failure, hypoproteinemia and fibrosing alveolitis were recruited for this study. Thirty-six crackles were analyzed in time and frequency domains; 12 in each category of low, medium and high frequencies. The acoustic features of the crackles, their segments (initial deflection width, first cycle duration, two cycles duration, decay segment) and the breath sounds following the crackles were compared. RESULTS: The study confirms the differences between the three crackles categories in time and frequency domains. No statistical differences were found between the decay segments and breath sounds in each category. CONCLUSIONS: Breath sounds modified by lung tissue density could be the main resonators determining the fundamental transmission frequencies of crackle signals. Combined acoustic analysis of crackles and breath sounds could replace single analysis of isolated crackles.
Subject(s)
Hearing/physiology , Lung/physiology , Physicians , Respiratory Sounds/diagnosis , Diagnosis, Differential , Humans , Lung Diseases/diagnosis , Respiratory Sounds/classification , SoundABSTRACT
Recent medical literature has shown that there has been renewed interest focused on the small airways deep in the lung tissue. Although there is involvement of the distal airways at an early stage in mucus secreting lung diseases, no specific chest physical therapy (CPT) manoeuver has been proposed for small airways clearance. A four-tier classification of CPT has been established with identification of its benefits at each level of a monoalveolar respiratory tract model. The usual expiratory techniques directed towards the upper and middle respiratory tract are not applicable to the small airways and new paradigm is proposed appropriate to their specific mechanical characteristics. This comprises a slow resistive inspiratory manoeuver in the lateral position. Clinical auscultation of the lung is the cornerstone of the validation and follow-up of the technique.
Subject(s)
Lung Diseases, Obstructive/therapy , Lung/physiology , Physical Therapy Modalities , Respiratory Mechanics/physiology , Humans , Lung Diseases, Obstructive/physiopathology , Models, Theoretical , Musculoskeletal Manipulations/methods , Physical Therapy Modalities/classification , Pulmonary Ventilation/physiology , ThoraxSubject(s)
Airway Obstruction/rehabilitation , Bronchiolitis, Viral/rehabilitation , Physical Therapy Modalities , Breathing Exercises/methods , Bronchiolitis, Viral/classification , Bronchiolitis, Viral/diagnosis , Combined Modality Therapy , Consensus , Contraindications , Cross-Cultural Comparison , Europe , Evidence-Based Medicine , France , Humans , Infant , Prescriptions , Treatment OutcomeSubject(s)
Respiratory Sounds , Terminology as Topic , Adult , Age Factors , Auscultation , Child, Preschool , Consensus , Fourier Analysis , France , HumansABSTRACT
In order to found the stethacoustic nomenclature on objective facts, we suggest to express lung sounds in a way taking first into account acoustical physics. Indeed the physicoacoustical definition of lung sounds has to take place before its psychoacoustical definition. Acoustical physics identifies only four kinds of vibrations: simple and complex periodical vibrations, transient and continuous non periodical vibrations. Lung sounds are bound to fall into one of those four categories. Phonopneumograms in time and frequency domain allow an objective classification of breath and adventitious lung sounds and introduce a simplification into the nomenclature which recognizes only four sorts of lung sounds, all of them included in these two categories: 1 degree breath sounds include normal and bronchial breath sounds, 2 degrees adventitious sounds include crackles (for every discontinuous sound) and wheezes (for every continuous sound). Objective parameters add their specific characteristics in terms of pitch, complexity, Hz-frequency, timing in the respiratory cycle and duration. The proposal of a new nomenclature is justified because it is supported by measurable physical phenomena. The solution of semantic problems should enable clinicians to progress toward a worldwide consensus.
