Key messages
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It is unclear whether chest physiotherapy is helpful for children with pneumonia. Studies tested different kinds of chest physiotherapy, but results varied across studies. Some techniques showed small improvements in recovery, whilst others showed no clear effect.
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Future studies should use similar methods and reporting of results to enable a clearer understanding of the effectiveness of chest physiotherapy for children with pneumonia.
What is pneumonia and chest physiotherapy?
Pneumonia is a type of lung infection. It is the deadliest infectious disease amongst children aged up to five years worldwide. Most pneumonia-related deaths occur in low- and middle-income countries, where access to healthcare services may be more limited than in high-income countries.
Chest physiotherapy is a type of physical therapy that loosens mucus in the lungs so it can be coughed out, making breathing easier. Because it can help to open airways and assist breathing, chest physiotherapy may contribute to children's recovery from pneumonia. Some forms of chest physiotherapy are administered by another person, such as a physiotherapist, whilst others are self-administered or require the use of a mechanical device.
What did we want to find out?
We wanted to find out if chest physiotherapy could reduce the number of deaths and length of hospital stay and improve symptoms in children with pneumonia. We also looked at any unwanted effects of chest physiotherapy.
What did we do?
We searched for studies that compared any type of chest physiotherapy with no chest physiotherapy in children with pneumonia. We compared and summarised the results of the studies and rated our confidence in the evidence based on factors such as study methods and sizes.
What did we find?
We included 12 studies involving a total of 2863 children with pneumonia aged from 29 days to 14 years. This is an update of a review first published in 2013 and updated in 2019, and includes six new studies. Studies were conducted in hospitals in Bangladesh, Brazil, China, Egypt, Ethiopia, Malawi, and South Africa. Pneumonia was described as moderate to severe in seven studies; severity was not described in the remaining five studies. All children also received standard medical treatment for pneumonia.
Main results
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There may be little to no difference between groups in number of deaths (6 studies, 2294 children).
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Of 9 studies (2069 children) that looked at length of hospital stay, 5 studies reported no difference between groups, whilst the other 4 studies found a shorter hospital stay in the group receiving chest physiotherapy.
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There may be little to no difference between groups in time to resolution of increased number of breaths taken per minute (respiratory rate) (11 studies, 2219 children).
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Three studies (336 children) found shorter cough and phlegm duration in children receiving chest physiotherapy, whereas 1 study (89 children) reported a longer coughing period.
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Six studies (2382 children) reported unwanted effects. Most studies found no serious unwanted effects, but mild complications such as nasal irritation, skin breakdown, or swollen belly were more common in children receiving chest physiotherapy.
Because the included studies were relatively small, tested different treatments, and reported results in different ways, we could not confirm whether chest physiotherapy is helpful or not for children with pneumonia. Decisions about the use of chest physiotherapy should therefore be based on the individual needs of the child and their condition.
What are the limitations of the evidence?
We have little to very low confidence in the evidence because studies were small and had problems with their methods, and results differed amongst studies. Studies used different methods and ways of reporting results, making it hard to clearly understand how effective these treatments are.
How up to date is this evidence?
The evidence is current to 8 June 2026.
Read the full abstract
Background
Pneumonia is a lung infection that causes more deaths in children aged under five years than any other single cause. Chest physiotherapy is widely used as adjuvant treatment for pneumonia. Physiotherapy is thought to help remove inflammatory exudates, tracheobronchial secretions, and airway obstructions, and reduce airway resistance to improve breathing and enhance gas exchange. This is an update of a review published in 2013.
Objectives
To assess the effectiveness of chest physiotherapy regarding time until clinical resolution in children (from birth to 18 years) of either gender with any type of pneumonia, irrespective of aetiology or clinical classification.
Search strategy
We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, CINAHL, LILACS, Web of Science, and PEDro and two clinical trial registries on 8 June 2026.
Selection criteria
We included randomised controlled trials (RCTs) that compared any type of chest physiotherapy with no chest physiotherapy for children with pneumonia.
Data collection and analysis
We used standard Cochrane methodological procedures. The primary outcomes of interest were mortality, duration of hospital stay, and time to clinical resolution. We used Review Manager 5 software to analyse data and GRADE to assess the quality of the evidence for each outcome.
Main results
We included three new RCTs for this update, for a total of six included RCTs involving 559 children aged from 29 days to 12 years with pneumonia who were treated as inpatients. Pneumonia severity was described as moderate in one trial, severe in two trials, and was not stated in three trials. The studies assessed five different interventions: effects of conventional chest physiotherapy (3 studies, 211 children), positive expiratory pressure (1 study, 72 children), continuous positive airway pressure (CPAP) (1 study, 94 children), bubble CPAP (bCPAP) (1 study, 225 children), and assisted autogenic drainage (1 studies, 29 children). The included studies were conducted in Bangladesh, Brazil, China, Egypt, and South Africa. The studies were overall at low risk of bias. Blinding of participants was not possible in most studies, but we considered that the outcomes were unlikely to be influenced by the lack of blinding.
One study of bCPAP reported that three deaths occurred in children in the physiotherapy group (N = 79), and 20 deaths in the control group (N = 146) (risk ratio (RR) 0.28, 95% confidence interval (CI) 0.08 to 0.90; 225 children; low-quality evidence). One study of assisted autogenic drainage (N = 29), and one study of conventional chest physiotherapy (N = 72) reported no deaths occurred. It is uncertain whether chest physiotherapy techniques (bCPAP, assisted autogenic drainage, and conventional chest physiotherapy) reduced hospital stay duration (days) (mean difference (MD) 0.10, 95% CI -0.56 to 0.76; 4 studies; low-quality evidence).
There was variation among clinical parameters used to define clinical resolution. Two small studies found no difference in resolution of fever between children in the physiotherapy (conventional chest physiotherapy and assisted autogenic drainage) and control groups. Of five studies that considered peripheral oxygen saturation levels, only two reported that use of chest physiotherapy (CPAP and conventional chest physiotherapy) showed a greater improvement in peripheral oxygen saturation levels. However, it was unclear whether respiratory rate (breaths/min) improved after conventional chest physiotherapy (MD -2.25, 95% CI -5.17 to 0.68; 2 studies, 122 children; low-quality evidence). Two studies assessed adverse events (number of events), but only one study reported any events (RR 1.28, 95% CI 0.98 to 1.67; 2 studies, 254 children; low-quality evidence).
Authors' conclusions
We could draw no reliable conclusions regarding the effectiveness of chest physiotherapy for children with pneumonia due to substantial variability in study characteristics and limitations in how data were presented and analysed across the included trials. Future research should ensure adequate methodological rigour, standardisation of physiotherapy techniques, appropriate outcome measures (such as duration of leukocytosis and airway clearance), and careful reporting of potential adverse effects.
Funding
The review authors declare no funding support or financial conflicts of interest.
Registration
Protocol (2012) DOI: doi.org/10.1002/14651858.CD010277
Original review (2013) DOI: doi.org/10.1002/14651858.CD010277.pub2
Review update (2019) DOI: doi.org/10.1002/14651858.CD010277.pub3
