Pneumonia is one of the most common health problems affecting all age groups around the world. Antibiotics represent the mainstay of pneumonia treatment, while other therapies are mostly supportive. Chest physiotherapy has been widely used as an adjunctive therapy for pneumonia in adults without any reliable evidence.
Six randomised controlled trials assessing 434 participants were included. The studies appraised four types of chest physiotherapy, namely conventional chest physiotherapy, osteopathic manipulative treatment (including paraspinal inhibition, rib raising, and diaphragmatic or soft myofascial release), active cycle of breathing techniques (including active breathing control, thoracic expansion exercises and forced expiration technique) and positive expiratory pressure. None of these techniques (versus no physiotherapy or placebo therapy) reduce mortality. Among three of the techniques (conventional chest physiotherapy, active cycle of breathing techniques and osteopathic manipulative treatment) there is no evidence to support a better cure rate in comparison with no physiotherapy or placebo therapy. Limited evidence indicates that positive expiratory pressure (versus no physiotherapy) and osteopathic manipulative treatment (versus placebo therapy) can slightly reduce the duration of hospital stay (by 2.02 and 1.4 days, respectively). In addition, positive expiratory pressure (versus no physiotherapy) can slightly reduce the duration of fever by 0.7 day, and osteopathic manipulative treatment (versus placebo therapy) might reduce the duration of antibiotic use by 1.93 days. No severe adverse events were found.
In summary, chest physiotherapy should not be recommended as routine additional treatment for pneumonia in adults. The limitation of our review is that six published studies which appear to meet the inclusion criteria are awaiting classification (five of which are published in Russian).