[Respiratory physiotherapy and respiratory mechanics of chronic respiratory insufficiency]

The effect of short, medium and long term physiotherapy remain controversial. The theoretical objectives of the method are to reduce dyspnoea and respiratory disability while improving exercise performance and expectation of life. As regards respiratory mechanics, the goals are to reduce bronchial obstruction and the mechanical properties of the chest wall. A rise in expiratory flow might result in an increased drainage of secretions, a reduction in transmural bronchial pressure and a raised level of ventilation at end-tidal volume. The correction of parietal distortions by physiotherapy has as an objective a diminution of thoracic elastance. Muscular training, a new aspect of respiratory physiotherapy, consists of increased both the endurance and the force of contraction of the respiratory muscles. The beneficial effects of these recent methods require confirmation with long term clinical studies. The correct indications for the diverse techniques proposed require a better understanding of the mechanism of action of respiratory physiotherapy, an essential complement to effective treatment of chronic airflow obstruction.