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Am Fam Physician. 2010;82(11):1340

Author disclosure: Dr. Ebell is Editor in Chief of Essential Evidence, published by John Wiley & Sons, Inc., who also publish The Cochrane Library.

Clinical Question

Does chest physiotherapy improve outcomes for adults with pneumonia?

Evidence-Based Answer

There is little evidence to support the effectiveness of chest physiotherapy for adults with pneumonia. In two small studies by the same investigator, only osteopathic manipulation was shown to improve some outcomes (i.e., length of stay and duration of antibiotic therapy). (Strength of Recommendation = B, based on inconsistent or limited-quality patient-oriented evidence)

Practice Pointers

Chest physiotherapy includes a variety of techniques, such as conventional chest physiotherapy (i.e., percussion and postural drainage), active cycle of breathing techniques, positive expiratory pressure (using devices to maintain 10 to 25 cm of water pressure during expiration), and osteopathic manipulation. In theory, these techniques could help keep airways open, improve secretion clearance, and increase gas exchange. Results from previous studies have been mixed, and there were no previous systematic reviews.

The authors of the Cochrane review identified six studies of chest physiotherapy in adult patients with acute pneumonia (n = 434). They did not include seven other studies that initially appeared to meet their inclusion criteria because five of them were published in Russian, one was unpublished, and one was published in 1947 and not available to the authors. All of the included studies were randomized; three of the studies blinded participants, two blinded outcome assessors, and three concealed allocation. Each patient received routine treatment (e.g., antibiotics, oxygen therapy). Additional treatment with chest physiotherapy was compared with placebo therapy in two of the studies, and with no therapy (i.e., routine treatment alone) in four of the studies. None of the interventions improved mortality or cure rate. Osteopathic manipulation, studied in two double-blinded, sham-controlled trials with 79 patients, appeared to reduce hospital length of stay by a mean of two days and the duration of antibiotic therapy.

These are summaries of reviews from the Cochrane Library.

This series is coordinated by Corey D. Fogleman, MD, assistant medical editor.

A collection of Cochrane for Clinicians published in AFP is available at

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