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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., (Copyright © 2018 SPLF. Published by Elsevier Masson SAS. All rights reserved.)

Every winter, numerous infants are hospitalized for acute bronchiolitis. The severity criteria and symptomatic treatment are well known, with chest physiotherapy codified in 2000 by the French Health Authority (HAS) consensus conference (with techniques varying from one country to another) and becoming nearly systematic for the treatment of bronchial obstruction in infants. However, is this treatment really effective and legitimate for acute bronchiolitis? The objective of this study was to review the main studies on this subject. Few studies are available and most have a low level of evidence. However, they all tend to agree that chest physiotherapy does not change the natural history of the disease and most particularly the duration of hospitalization. Therefore, it does not seem that the prescription of chest physiotherapy in infant acute bronchiolitis is recommended., (Copyright © 2014 Elsevier Masson SAS. All rights reserved.)

The working group on aerosol therapy (GAT) of the Société de pneumologie de langue française (SPLF) organized its third "Aerosolstorming" in 2012. During the course of one day, different aspects of inhaled therapy were discussed, and these will be treated separately in two articles, this one being the first. Inhaled products represent a large volume of prescriptions both in the community and in hospital settings and they involve various specialties particularly ENT and respiratory care. Technical aspects of the development of these products, their mode of administration and compliance with their indications are key elements for the effective therapeutic use of inhaled treatments. In this first article, we will review issues concerning generic inhaled products, the existence of inhaled antidotes, new anti-infective agents and indications for inhaled pentamidine., (Copyright © 2013 SPLF. Published by Elsevier Masson SAS. All rights reserved.)

The working group on aerosol therapy (GAT) of the Société de Pneumologie de Langue Française (SPLF) has organized its third Aerosolstorming in 2012. During one single day, different aspects of inhaled therapies have been treated and are detailed in two articles, this one being the second. This text deals with the indications of inhaled corticosteroids in ENT, the development and technical challenges of powder inhalers, the advantages and disadvantages of each type of technologies to measure the particle sizes of inhaled treatments., (Copyright © 2013 SPLF. Published by Elsevier Masson SAS. All rights reserved.)

Communications from the 2011 meeting of the GAT are reported in this second article on the practical management of bronchial provocation tests and infectious risks associated with the use of nebulization. Recent advances on the role of nebulized hypertonic saline in the treatment of acute bronchiolitis in infants and of the nebulization in sinusal diseases are also reported., (© 2012 SPLF. Published by Elsevier Masson SAS. All rights reserved.)

Introduction: Dry powder inhalers (DPIs) require a certain threshold of inspiratory effort to generate respirable particles. We undertook a literature review to determine whether this may, in particular clinical settings (young children, elderly subjects, acute or chronic respiratory obstructive syndromes - asthma and COPD), constitute a limitation on their use., State of the Art: Currently marketed DPIs exhibit different technical characteristics. Many factors may influence their efficacy, so that the predictive utility of in vitro tests is limited. Published clinical studies indicate that aerosol therapies inhaled with DPIs show clinical efficacy even at low inspiratory air flows in adults and children with acute asthma, in acute bronchoconstriction experimentally provoked by methacholine or histamine, in acute asthma attacks in adults and children, and in COPD-related airway obstruction. The efficacy of DPIs appears comparable to that of p-MDIs or nebulisation. However, the studies often have some limitations (including limited statistical power and patient selection) that may affect their value., Perspectives: The published studies analysed suggest that DPIs may be used in the great majority of clinical situations, subject to careful patient education. Nevertheless, p-MDIs with spacers remain recommended by international guidelines for children under the age of 6., Conclusions: Additional well-designed clinical studies remain desirable to establish firmly the efficacy of DPIs in these situations.

Numerous advances have been made during these last years for the optimization of inhaled therapy in children. The use of the best device adapted to the age of the child, the decrease of the electrostatic forces inherent to the plastic walls of the spacer devices, the importance of the right combination of drug and device for generating droplets susceptible to be deposited into the lungs, and the knowledge of drug that can be inhaled once daily have improved the efficacy of inhaled therapy. Development of novel devices that address the limitations of conventional devices is a new step. Novel liquid-based devices (pressurized metered-dose inhaler and nebulizer) can be grouped into three types: mechanical (mechanical energy is generated with a piston or a spring), vibrational (reservoir of fluid or membrane which vibrates at ultrasonic frequencies), and electrostatic (use of an electric field for transforming liquid to fine particles spray). Re-usable dry powder inhaler, allowing the delivery of different drugs, is currently tested. Such improvements in the inhaled therapy permit to treat respiratory diseases of course, but also other extra-pulmonary diseases like diabetes mellitus, pulmonary hypertension, dolor, and even to deliver vaccines. [Copyright &y& Elsevier]

Abstract: The revival of nebulization as a drug delivery route is real. The current delivery systems respond to the new European norms, the new mesh-vibrating nebulizers allow delivering drugs more quickly, other nebulizers, more performant because of less drug losses and of a better lung deposition of the drug, are in progress. Only 12 drugs are commercialized for nebulization. All are available in dispensaries, some requiring a first prescription by a physician working in a hospital (cystic fibrosis drugs), others requiring a prescription from only some specialists as paediatricians or pulmonologists (bronchodilators). Works are in progress concerning the diameter and shape of the drug particles (nanotechnology) and also concerning the use of nebulized drugs for a systemic effect (vaccines, insulin, cyclosporine, anticancerous agents, etc.). [Copyright &y& Elsevier]