Physiotherapy in severe bronchiolitis: challenges, precautions and limitations

Abstract

Acute bronchiolitis in infants is, during each epidemic season, the most common respiratory condition among children under one year of age. Although usually mild, it requires careful monitoring to identify at-risk infants and severe forms of the disease. In France, community-based physiotherapists may be involved in the follow-up of these infants and can play a key role in early detection. Regular clinical assessment allows them to identify signs of severity and initiate prompt referral to hospital care. In hospital settings, the management of severe bronchiolitis is symptomatic and relies on supportive treatments (oxygen therapy and hydration/nutritional support). Current guidelines no longer recommend lower airway clearance techniques, except in specific situations (e.g., respiratory or neurological comorbidities), but highlight the usefulness of upper airway clearance to improve respiratory comfort and feeding. This review emphasizes the central role physiotherapists can play by fully embracing this surveillance function within the care pathway, combining clinical vigilance, judicious use of symptomatic treatments, and coordination with other healthcare professionals to optimize the management of severe bronchiolitis.