[Technics and results in respiratory kinesitherapy of chronic obstructive bronchopneumopathies]

The rehabilitation of patients with chronic airflow obstruction consists of a number of complementary treatments, one of which is respiratory physiotherapy (KR). Breathing exercises (RE), bronchial drainage and controlled coughing are all part of current techniques in physiotherapy. As problems with the rhythm of breathing are frequently encountered in patients with chronic pulmonary disease, their correction is attempted with KR. In order to acquire a new, more efficient breathing pattern, training in simple every day measures is used (such as talking, reading watching TV, walking, climbing stairs, etc.) or techniques using mechanical devices, including inventive spirometers and magnetometers. With a few exceptions, most of the studies show an immediate objective benefit on blood gases and alveolar ventilation, due to a reduced respiratory rate and increased tidal volume. Although dynamic ventilatory work increases, neither the pulmonary haemodynamics nor energy expenditure are altered as judged by oxygen consumption during RE. The long term results are contradictory and more difficult to interpret. Many studies have noted a clinical and functional improvement with fewer relapses and hospital admissions; these studies often lack adequate controls and the clinical state is not always precisely defined; nor whether associated therapy has been changed or not. Other studies have given negative results, and lately the causes of these failures have been better defined. There is insufficient theoretical and practical training of KR at all medical levels, an absence of uniformity in the KR rehabilitation teams, and treatment courses which are both too few in number and too short in duration. An appreciation of these points of criticism should make for greater objectivity in the future analysis of pulmonary rehabilitation.