Efficacy of physical therapy methods in airway clearance in patients with chronic obstructive pulmonary disease: a critical review.

Multiplicity and variety of chest physical therapy (CPT) methods for increasing bronchial clearance in patients with chronic obstructive pulmonary disease (COPD) require an assessment of validity and reliability of the available clinical evidence. The aim of the review was to evaluate publications on CPT in COPD patients and to establish the basis (objective criteria) on which given methods and techniques are recommended or refuted. Systematic reviews, narrative reviews, and clinical practice guidelines, published in English between January 1, 2000 and July 1, 2010, were identified from the PubMed/MEDLINE and Cochrane (DARE, CRD, The Cochrane Airways Review Group Register) databases. The PEDro and SIGN scales were used to assess the quality and grade of recommendations for selected papers. Generally, the papers that we identified were based on small studies, limited to short-term outcomes, mostly using crossover designs, and rarely including sham therapy. Recommendations from clinical guidelines were mainly grade C or D. Health-related quality-of-life analyses, including working and exercise capacity, are lacking. The evidence from the studies in patients with cystic fibrosis cannot be directly extrapolated to COPD subjects. Despite the lack of convincing evidence, clinical practice supports the value of CPT in COPD. However, when making a clinical decision, potential side effects should be considered.