First, the clinic
The author of the method, Guy Postiaux, is chest physiotherapist. He got interested early to clinic and more specifically respiratory sounds , which constituted its first scientific works at the ILSA (International Lung Sounds Association) and at the CORSA (Computerized Respiratory Sounds Analysis) supported by the European Community (BIOMED 1 Concerted Action Project).
Numerous clinical stethacoustic and experimental observations were realized at the service ok internal medicine and the applied acoustic laboratory of the Groupe d'Etude Pluridisciplinaire Stéthacoustique located in the CHNDRF - Clinique Reine Fabiola at 6000 Charleroi-Belgium, in collaboration with Dr Emile Lens. Guy Postiaux felt the need to question usual techniques of cCPT, postural drainage and clapping (conventional CPT), among others, demonstrating those methods were obsolete and of little efficiency. His research led to the new approach of nCPT (new Chest Physiotherapy) of the bronchopulmonary obstruction of the adult, child, infant and newborn. He managed to establish the first scientific bases from a personal concept.
This new method is validated and was part of numerous papers and communications in scientific journals as in medical and physiotherapy congresses around the world. It is adapted to any practice of the outcome or hospitalized patient. It allows the issue of direct results, real and observable. For more than 15 years, it is tought to practicians in the purpose to give them the appropriate tools to care with efficiency, with respect to costs and requirements of the updated Evidence Based Medicine.
CPT can be applied by various ways, mainly because of historical reasons. Some tendencies grow stronger, while others appear. Anglo-saxon countries rather use a conventional cCPT which calls on forced expirations, postural drainage, clapping, modifying or adapting these techniques. The adaptation being the most important element of the efficacy, like PEP-positive expiration pressure. Continental-latin Europe, Scandinavian countries and Latin America rather differenciate and use more innovating techniques like slow expiratory and inspiratory techniques, which make more and more adepts, because they offer more precise action in the distal airways and that they are clearly better tolerated.
The reflexion was very critical towards conventionnal techniques due to their limits and counter effects. The most dissapproved fact was the transposition of the PD from those conventionnal techniques to the newborn, which made the technique of child bronchial clearance seem inefficient, thus useless and possibly dangerous in english countries. The reason of this different view is mainly historical but also methodological.
Several important events contributed to the evolution of CPT over the last few years.
- The first occured probably at the "1st Conférence de Consensus sur la Toilette Bronchique" (Lyon-Fr, déc. 1994) during which the conventionnal techniques were quite relativised and new exploring techniques slowly recognized.
- The second event was the "Conférence de Consensus sur la Prise en Charge de la Bronchiolite du Nourrisson" (Paris septembre 2000, Arch Fr Pediatr 2001; 8 suppl, 1: 1-196) where the primordial role of nCPT was recognized. Infant nCPT could finally be accepted.
- The third occured at the "Journées Internationales de Kinésithérapie Respiratoire Instrumentale-JIKRI" (Lyon-Fr, nov 2000).
Those three conferences and the recommendations made allowed the " set up " of the State of The Art in bronchopulmonary clearance techniques.
For 2 years now, the "Société de Pneumologie de Langue Française-SPLF" allows the presentation of a new type of cCPT called " kinésithérapie inspiratoire " where basic methodologies in the treatment of acute peumopathy are discussed. Independent from the future results, a variety of projects can come out of these discussion.
Which patients can benefit ?
The first publications, by british researchers, describe cCPT of chronic patients (chronic obstructive pulmonary disease-COPD) and mainly cystic fibrosis patients. Those diseases, even though very heavy and where CPT is an important factor of survival, only constitute a small part of the obstructive diseases. In addition, patients studied were children hospitalized in clinics related to research centers. Limiting the indications to those concluded from those only studies is not sufficient.
We can wonder what happens to the little patients not affected by those diseases but by others like bronchiolitis, bronchitis, asthma, like also situations of extrathoracic airways obstruction which occasionnally impact little children, like states of hypersecretion from various etiologies, all pathologies that constitute less and less reasons for hospital intake due to the efficacy of applied treatments (like nCPT). It is of course beneficial for the children, for their families expense but also public healthcare budget! Still those little patients do not make part of studies though we all know that acute respiratory diseases in infancy pave de way for respiratory deficiencies of the adolescent and the adult. Fortunately in French speaking Europe, nCPT became integral part, if not the major element, of the medical treatment of the infant bronchiolitis.
NO GOLDEN STANDARD
Recent studies could help precise the practical methods and the indications of several techniques, though it appears not any method can be considered as the golden standard, not any method is the ideal treatment of bronchial obstruction. Variety of diseases impose an individual consideration of each case and its adapted treatment, made feasible by the "specific physiotherapic assessment set up" and toughtand teached by Guy Postiaux. Beyond the studies also lies the therapist clinical common sense. Like medicine, physiotherapy is as an art than a science.
LA PEDIATRIE : UNE SPECIALISATION NECESSAIRE
The "Conférence de Consensus sur la Bronchiolite du Nourrisson" (Paris-Fr, sept 2000) mentionned in its conclusion the need to allow physiotherapist to follow permanent specialized course in the matter. nCPT in infant is not trivial and should only be performed by skilled personal. Training includes care techniques and methods of clinical evaluation, particularly auscultation.
As the variable airway obstruction and hyperinflation are the most currently observed functionnal signs of pediatric respiratory diseases, obstruction for its part is mainly announced by wheezes, may the child be asmathic or not. The monitoring of the parameters of adventitious sounds is an immediate way to control the benefits or adverse effects of the treatment. Clinical common sense and a carefull auscultation remain the essential root to the elaboration of a logical therapeutic behavior and potentially efficient, even more knowing that ethical responsibility and the physiotherapy technique are of importance in cities, where the major treatments take place.