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https://assobrafirciencia.org/article/doi/10.47066/2177-9333.AC.2019.0006
ASSOBRAFIR Ciência
Artigo de Revisão

Intervenções de fisioterapia respiratória para crianças e adolescentes com fibrose cística: uma revisão integrativa

Respiratory physiotherapy interventions for children and adolescents with cystic fibrosis: an integrative review

Amanda Franciele Valandro, João Paulo Heinzmann-Filho

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Resumo

Introdução: A fibrose cística é uma doença multissistêmica, sendo as complicações respiratórias, as principais responsáveis pela morbimortalidade da doença. O tratamento envolve equipe multidisciplinar, no qual, a fisioterapia respiratória tem como objetivo otimizar a função pulmonar. Diversas intervenções de fisioterapia respiratória (convencionais, baseadas em volume, instrumentais e exercícios ventilatórios) são utilizadas no tratamento da fibrose cística, e mapear os estudos relacionados a elas contribui no manejo da doença. Objetivo: Revisar as intervenções fisioterapêuticas apresentadas, na literatura indicada, para remoção de secreção das vias aéreas de crianças e adolescentes com fibrose cística. Métodos: Trata-se de uma revisão integrativa, realizada através do Pubmed, LILACS, SciELO, Cochrane e PEDro. Utilizou-se a seguinte estratégia de busca: cystic fibrosis AND physical therapy modalities OR bronchial hygiene. Foram incluídos estudos que utilizaram intervenções fisioterapêuticas para a remoção de secreção das vias aéreas de crianças e adolescentes com fibrose cística. Resultados: De um total de 1.526 artigos, apenas 22 foram incluídos. Os artigos totalizaram 708 participantes, com idades oscilando entre três semanas e 18 anos. As intervenções fisioterapêuticas utilizadas apresentaram variabilidade, sendo, as mais frequentes, as convencionais (drenagem postural, percussão, vibração), em 16/22 estudos, seguidos das instrumentais (dispositivo/máscara de pressão expiratória positiva e Flutter®), em 12/22, dos exercícios ventilatórios (7/22) e das baseadas em volume (ciclo ativo da respiração, drenagem autogênica) em 6/22 artigos. Além disso, conforme ocorre um aumento da faixa etária, há uma redução por intervenções fisioterapêuticas exclusivamente convencionais. Conclusão: Houve grande variabilidade nas intervenções de fisioterapia respiratória utilizadas para a remoção de secreção das vias aéreas nesse mapeamento realizado em crianças e adolescentes com fibrose cística. No entanto, evidenciou-se certo predomínio de intervenções convencionais. A escolha da terapêutica parece ter sido influenciada pela idade dos participantes.

Palavras-chave

Fibrose Cística; Modalidades de Fisioterapia; Higiene Brônquica; Pediatria.

Abstract

Introduction: Cystic fibrosis is a multisystemic disease with respiratory complications the main factor responsible for the morbidity and mortality caused by the disease. The treatment requires a multidisciplinary team, in which chest physiotherapy aims to optimize pulmonary function. Several respiratory physiotherapy interventions (conventional, volume-based, instrumental and ventilatory exercises) are used in the treatment of cystic fibrosis. To review the available evidence of these techniques helps to improve the management of the disease. Objective: To review physical therapy interventions of airway clearance for children and adolescents with cystic fibrosis. Methods: It is an integrative review, carried out via Pubmed, LILACS, SciELO, Cochrane and PEDro. The following search strategy was used: cystic fibrosis AND physical therapy modalities OR bronchial hygiene. Studies that used physical therapy interventions to remove airway secretion in children and adolescents with cystic fibrosis were included. Results: In a total of 1.526 articles, only 22 were included. The articles totalled 708 participants, with their ages ranging from three weeks to 18 years. There was a large variability of physical therapy interventions with conventional techniques (postural drainage, percussion, vibration) the most frequent ones (16 studies). The second most prevalent techniques (12 studies) were instrumental (positive expiratory pressure device/mask and Flutter®), followed by ventilatory exercises (7 studies) and volume-based exercises (active breathing cycle, autogenic drainage) in 6 studies. Additionally, with the increase of age, fewer interventions using exclusively conventional techniques tend to be applied. Conclusion: There was considerable variability in respiratory physiotherapy interventions used to remove secretions from the airways in this review performed in children and adolescents with cystic fibrosis. However, there was a predominance of conventional interventions. The choice of therapy seems to have been influenced by the age of the participants.

Keywords

Cystic Fibrosis; Physical Therapy Modalities; Bronchial Hygiene; Paediatrics.

Referências

1. Paranjape SM, Mogayzel PJ Jr. Cystic Fibrosis. Pediatr Rev. 2014 May;35(5):194-205. doi: 10.1542/pir.35-5-194.

2. Rafeeq MM, Murad HAS. Cystic fbrosis: current therapeutic targets and future approaches. J Transl Med. 2017 Apr 27;15(1):84. doi: 10.1186/s12967-017-1193-9.

3. Feiten Tdos S, Flores JS, Farias BL, Rovedder PM, Camargo EG, Dalcin Pde T, et al. Respiratory therapy: a problem among children and adolescents with cystic fibrosis. J Bras Pneumol. 2016 JanFeb;42(1):29-34. doi: 10.1590/S1806-37562016000000068.

4. Athanazio RA, Silva Filho LVRF, Vergara AA, Ribeiro AF, Riedi CA, Procianoy EFA, et al. Diretrizes brasileiras de diagnóstico e tratamento da fibrose cística. J Bras Pneumol. 2017;43(3):219-45. doi: 10.1590/S1806-37562017000000065.

5. Dalcin PDTR, Abreu e Silva FAD. Cystic fibrosis in adults: diagnostic and therapeutic aspects. J Bras Pneumol. 2008 Feb;34(2):107-17.

6. Sociedade Brasileira de Pneumologia. Fibrose Cística: Diagnóstico e tratamento [internet]. Brasília: SBPT; [2019; cited 2019 Mar 21]. Available from: https://sbpt.org.br/portal/publico-geral/fibrosecistica-diagnostico-tratamento/

7. Lannefors L, Button BM, McIlwaine M. Physiotherapy in infants and young children with cystic fibrosis: current practice and future developments. J R Soc Med. 2004;97 Suppl 44(Suppl 44):8-25.

8. Donadio MV, Campos NE, Vendrusculo FM, Stofella AM, Almeida ACS, Ziegler B, et al. Respiratory physical therapy techniques recommended for patients with cystic fibrosis treated in specialized centers. Braz J Phys Ther. 2019 Nov 29:S1413-3555(19)30062-0. doi: 10.1016/j.bjpt.2019.11.003. Online ahead of print.

9. Warnock L, Gates A. Chest physiotherapy compared to no chest physiotherapy for cystic fibrosis. Cochrane Database Syst Rev. 2015 Dec 21;2015(12):CD001401. doi: 10.1002/14651858.CD001401. pub3.

10. Schivinski CIS, Stofella AM, Almeida ACS, Scalco JC, Parazzi PLF, Gonçalves Wamosy RMG. Parte 1. Avaliação do paciente com fibrose cística [Recomendação Brasileira de Fisioterapia na Fibrose Cística, um guia de boas práticas clínicas]. ASSOBRAFIR Ciência. 2019 Maio;10(Supl 1):21-60.

11. Brasil. Lei federal nº 8069, de 13 de julho de 1990. Estatuto da criança e do adolescente [Internet]. Brasília; 1990 [cited 2019 Mar 21]. Available from: https://legislacao.presidencia.gov.br/atos/?tipo=LEI&numero=8069&ano=1990&ato=461cXRq1keFpWT13a

12. Voldby C, Green K, Rosthøj S, Kongstad T, Philipsen L, Buchvald F, et al. The effect of time-of-day and chest physiotherapy on multiple breath washout measures in children with clinically stable cystic fibrosis. PLoS One. 2018 Jan 10;13(1):e0190894. doi: 10.1371/journal.pone.0190894. eCollection 2018.

13. Brilhante SA, Florêncio RB, Gualdi LP, Resqueti VR, Aliverti A, Andrade AFD, et al. Comparison of different levels of positive expiratory pressure on chest wall volumes in healthy children and patients with fibrosis. Fisioter Pesqui. 2017 Jul-Sept;24(3):311-20. doi: 10.1590/1809-2950/17015824032017

14. Reix P, Aubert F, Werck-Gallois MC, Toutain A, Mazzocchi C, Moreux N, et al. Exercise with incorporated expiratory manoeuvres was as effective as breathing techniques for airway clearance in children with cystic fibrosis: a randomised crossover trial. J Physiother. 2012;58(4):241-7. doi: 10.1016/S1836-9553(12)70125-X.

15. Moeller A, Stampfli SF, Rueckert B, Rechsteiner T, Hamacher J, Wildhaber JH. Effects of a ShortTerm Rehabilitation Program on Airway Inflammation in Children With Cystic Fibrosis. Pediatr Pulmonol. 2010 Jun;45(6):541-51. doi: 10.1002/ppul.21167.

16. West K, Wallen M, Follett J. Acapella vs. PEP mask therapy: A randomised trial in children with cystic fibrosis during respiratory exacerbation. Physiother Theory Pract. 2010 Apr 22;26(3):143-9. doi: 10.3109/09593980903015268.

17. Fuchs SI, Toussaint S, Edlhaimb B, Ballmann M, Gappa M. Short-Term Effect of Physiotherapy on Variability of the Lung Clearance Index in Children With Cystic Fibrosis. Pediatr Pulmonol. 2010 Mar;45(3):301-6. doi: 10.1002/ppul.21180.

18. McIlwaine M, Wong LT, Chilvers M, Davidson GF. Long-Term Comparative Trial of Two Different Physiotherapy Techniques; Postural Drainage With Percussion and Autogenic Drainage, in the treatment of Cystic Fibrosis. Pediatr Pulmonol. 2010 Nov;45(11):1064-9. doi: 10.1002/ppul.21247.

19. Farbotko K, Wilson C, Watter P, MacDonald J. Change in physiotherapy management of children with cystic fibrosis in a large urban hospital. Physiother Theory Pract. Jan-Mar 2005;21(1):13-21. doi: 10.1080/09593980590911480.

20. Button BM, Heine RG, Catto-Smith AG, Phelan PD, Olinsky A. Chest physiotherapy, gastrooesophageal reflux, and arousal in infants with cystic fibrosis. Arch Dis Child. 2004 May;89(5):435-9. doi: 10.1136/adc.2003.033100.

21. Button BM, Heine RG, Catto-Smith AG, Olinsky A, Phelan PD, Ditchfield MR, et al. Chest Physiotherapy in Infants With Cystic Fibrosis: To Tip or Not? A Five-Year Study. Pediatr Pulmonol. 2003 Mar;35(3):208-13. doi: 10.1002/ppul.10227.

22. Williams MT, Parsons DW, Frick RA, Ellis ER, Martin AJ, Giles SE, et al. Acute respiratory infection in patients with cystic fibrosis with mild pulmonary impairment: Comparison of two physiotherapy regimens. Aust J Physiother. 2001;47(4):227-36. doi: 10.1016/s0004-9514(14)60270-1.

23. Button BM, Heine RG, Catto-Smith AG, Phelan PD. Postural drainage in cystic fibrosis: Is there a link with gastro-oesophageal reflux? J Paediatr Child Health. 1998 Aug;34(4):330-4. doi: 10.1046/j.1440-1754.1998.00236.x.

24. Button BM, Heine RG, Catto-Smith AG, Phelan PD, Olinsky A. Postural drainage and gastrooesophageal reflux in infants with cystic fibrosis. Arch Dis Child. 1997 Feb;76(2):148-50. doi: 10.1136/ adc.76.2.148.

25. Mcllwaine M, Wong LT, Peacock D, Davidson GF. Long-term comparative trial of conventional postural drainage and percussion versus positive expiratory physiotherapy in the treatment of cystic fibrosis. J Pediatr. 1997 Oct;131(4):570-4. doi: 10.1016/s0022-3476(97)70064-7.

26. Cerny FJ. Relative Effects of Bronchial Drainage and Exercise for In-Hospital Care of Patients with Cystic Fibrosis. Phys Ther. 1989 Aug;69(8):633-9. doi: 10.1093/ptj/69.8.633.

27. Maayan C, Bar-Yishay E, Yaacobi T, Marcus Y, Katznelson D, Yahav Y, et al. Immediate Effect of Various Treatments on Lung Function in Infants with Cystic Fibrosis. Respiration. 1989;55(3):144-51. doi: 10.1159/000195725.

28. Bain J, Bishop J, Olinsky A. Evaluation of directed coughing in cystic fibrosis. Br J Dis Chest. 1988 Apr;82(2):138-48. doi: 10.1016/0007-0971(88)90034-4.

29. Van Asperen PP, Jackson L, Hennessy P, Brown J. Comparison of a positive expiratory pressure (PEP) mask with postural drainage in patients with cystic fibrosis. Aust Paediatr J. 1987 Oct;23(5):283-4. doi: 10.1111/j.1440-1754.1987.tb00272.x.

30. Tyrrell JC, Hiller EJ, Martin J. Face mask physiotherapy in cystic fibrosis. Arch Dis Child. 1986 Jun;61(6):598-600. doi: 10.1136/adc.61.6.598.

31. Desmond KJ, Schwenk WF, Thomas E, Beaudry PH, Coates AL. Immediate and long-term physiotherapy in patients effects of chest with cystic fibrosis. J Pediatr. 1983 Oct;103(4):538-42. doi: 10.1016/s0022-3476(83)80579-4.

32. Weller PH, Bush E, Preece MA, Matthew DJ. Short-Term Effects of Chest Physiotherapy on Pulmonary Function in Children with Cystic Fibrosis. Respiration. 1980;40(1):53-6. doi: 10.1159/000194251.

33. Main E, Prasad A, Schans C. Conventional chest physiotherapy compared to other airway clearance techniques for cystic fibrosis. Cochrane Database Syst Rev. 2005 Jan 25;2005(1):CD002011. doi: 10.1002/14651858.CD002011.pub2.

34. McIlwaine M, Button B, Dwan K. Positive expiratory pressure physiotherapy for airway clearance in people with cystic fibrosis. Cochrane Database Syst Rev. 2015 Jun 17;(6):CD003147. doi: 10.1002/14651858.CD003147.pub4.

35. Morrison L, Innes S. Oscillating devices for airway clearance in people with cystic fibrosis. Cochrane Database Syst Rev. 2017 May 4;5(5):CD006842. doi: 10.1002/14651858.CD006842.pub4.

36. Wilson LM, Morrison L, Robinson KA. Airway clearance techniques for cystic fibrosis: an overview of Cochrane systematic reviews. Cochrane Database Syst Rev. 2019 Jan 24;1(1):CD011231. doi: 10.1002/14651858.CD011231.pub2.

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