A critical evaluation of bronchial hygiene in pediatric pulmonary disease

The variables inherent in analyzing the effectiveness of modalities used to achieve bronchial hygiene are numerous. Treatments may be given in a variety of settings, including intensive-care units, pediatric wards, respiratiory therapy departments, physical therapy departments, chronic-care hospitals, special education centers, and patient homes. Treatments are administered by a variety of medical professionals, allied health personnel, and lay volunteers. Motivation of the care providers as well as of the patients may vary greatly. Also, efforts are needed to study patients at comparable stages in their growth and development and in the progression of their particular diseases. Rather than perpetuating the unquestioning use of these various treatments, a series of carfully constructed and controlled studies done in collaborative fashion need to be performed. Until that time, the recommendations we have outlined dealing with each of the various segments of bronchial hygiene may serve as useful guidelines.