Eficacia de la fisioterapia respiratoria en pacientes con enfermedad pulmonar obstructiva crónica (EPOC): revisión sistemática ampliada

• Autores: Ignacio Conde Arias, Raquel Magaz Montaner, Patricia Costa Rodriguez, Ana María Lascorz Goicoechea, Andrea Fumanal Escartín, Teresa Sierra Pascual
• Localización: Revista Sanitaria de Investigación, ISSN-e 2660-7085, Vol. 6, Nº. 9, 2025
• Idioma: español
• Enlaces
  • Texto completo
• Resumen
  • español

    Objetivo: Analizar de manera exhaustiva la efectividad de la fisioterapia respiratoria en pacientes con EPOC, evaluando su impacto sobre la función pulmonar, la capacidad funcional, la calidad de vida y la reducción de hospitalizaciones.

    Metodología: Se realizó una revisión sistemática ampliada de la literatura en PubMed, PEDro, Scopus y Cochrane Library hasta junio de 2025. Se incluyeron ensayos clínicos aleatorizados y estudios controlados que comparan distintas técnicas de fisioterapia respiratoria (ejercicios respiratorios, entrenamiento muscular inspiratorio, técnicas de higiene bronquial y dispositivos de presión positiva) con cuidados habituales o intervenciones educativas. Se analizaron variables de función pulmonar (FEV1, FVC), capacidad de ejercicio (6MWT, prueba de escalones), disnea (MRC, Borg) y calidad de vida (SGRQ, CAT). La calidad metodológica se valoró con la escala PEDro.

    Resultados: Se incluyeron 37 estudios con un total de 6.200 pacientes. Los programas de fisioterapia respiratoria demostraron mejoras significativas en la distancia recorrida en el 6MWT (+52 m), reducciones en disnea medida con MRC (−1 punto) y mejoría en calidad de vida con reducciones en el SGRQ de hasta −8 puntos. El entrenamiento muscular inspiratorio fue especialmente efectivo en pacientes con debilidad diafragmática, mientras que las técnicas de higiene bronquial mostraron mayor utilidad en pacientes con fenotipo bronquitis crónica. Se observó además una reducción del 25% en las hospitalizaciones anuales por exacerbaciones.

    Conclusiones: La fisioterapia respiratoria es una intervención segura, eficaz y coste-efectiva en la EPOC.

  • English

    Objective: To comprehensively evaluate the effectiveness of respiratory physiotherapy in patients with chronic obstructive pulmonary disease (COPD), assessing its impact on lung function, exercise capacity, quality of life, and hospitalizations.

    Methods: An extended systematic review was conducted in PubMed, PEDro, Scopus and Cochrane Library until June 2025. Randomized controlled trials and controlled studies comparing respiratory physiotherapy techniques (breathing exercises, inspiratory muscle training, bronchial hygiene, and positive pressure devices) with usual care or educational interventions were included. Outcomes were lung function (FEV1, FVC), exercise capacity (6MWT, step test), dyspnea (MRC, Borg), and quality of life (SGRQ, CAT). Methodological quality was assessed with the PEDro scale.

    Results: Thirty-seven studies involving 6,200 patients were included. Respiratory physiotherapy programs significantly improved 6MWT distance (+52 m), reduced dyspnea (MRC −1 point), and enhanced quality of life with SGRQ reductions up to −8 points. Inspiratory muscle training was particularly effective in patients with diaphragmatic weakness, while bronchial hygiene techniques were most useful in chronic bronchitis phenotypes. A 25% reduction in annual hospitalizations due to exacerbations was also observed.

    Conclusions: Respiratory physiotherapy is a safe, effective and cost-efficient intervention in COPD and should be systematically integrated into pulmonary rehabilitation programs.

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