Lennon, Marley and the paediatric asthma physiotherapist: all things we lost in the 1980s

Published:January 08, 2022DOI:https://doi.org/10.1016/j.paed.2021.12.006


      The management of asthma in children and young people changed dramatically in the 1980s, with the advent of inhaled corticosteroids and long-acting beta-2 agonists. The focus on these revolutionary new pharmaceuticals eclipsed previous therapy approaches that helped people with poorly controlled asthma, including physiotherapy. The number of deaths due to asthma initially fell, before plateauing, and despite a second revolution of targeted biological drugs, asthma deaths remain at an unacceptably high level. With this comes the realisation that asthma is much more complex than just the pathophysiological process; there are identifiable treatable traits, co-morbidity components and socioeconomic factors, meaning that an individualised approach, targeting the multidimensional components around asthma, has the biggest impact on symptoms and quality-of-life. Small pockets of excellence around the UK are leading the way in demonstrating the benefits of physiotherapist-led interventions, such as exercise and breathing retraining for dysfunctional breathing, in improving the health and wellbeing of young people with asthma. However, despite physiotherapy being recommended for children and adolescents with asthma, services remain sparse, under-resourced and under-used. This article provides a potted history of the demise and rebuilding of specialist physiotherapy provision within services for asthma. We review the innovations and research across the UK and suggest how we can break down barriers to accessing specialist physiotherapy within this new era of a modern, digitised NHS.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic and Personal
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Paediatrics and Child Health
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Wells C.
        • Fleming L.
        • Collins N.
        • Barker N.
        • Bush A.
        • Saglani S.
        Physiotherapy in children with difficult asthma: an exploratory cross-sectional survey of UK services.
        J Assoc Chart Physiotherap Respir Care. 2019; 51: 64-76
        • Yin G.
        • Xie Z.
        • Wu P.
        • et al.
        Appropriate physical training helps to relieve clinical symptoms of pediatric asthma. A meta-analysis.
        Int J Clin Exp Med. 2019; 12: 2079-2087
        • Hepworth C.
        • Sinha I.
        • Saint G.L.
        • Hawcutt D.B.
        Assessing the impact of breathing retraining on asthma symptoms and dysfunctional breathing in children.
        Pediatr Pulmonol. 2019 Jun; 54 (PMID: 30938089): 706-712https://doi.org/10.1002/ppul.24300
        • Barker N.
        • Elphick H.
        • Everard M.
        The impact of a dedicated physiotherapist clinic for children with dysfunctional breathing.
        ERJ Open Res. 2016; 2 (PMID 27957485): 103-2015https://doi.org/10.1183/23120541.00103-2015

      Further reading

        • Barker N.
        • Thevasagayam R.
        • Ugonna K.
        • Kirkby J.
        Paediatric Dysfunctional Breathing: proposed components, mechanisms, diagnosis, and management.
        Front Paediatr. 2020; 8: 379https://doi.org/10.3389/fped.2020.00379
        • British Thoracic Society
        British guideline on the management of asthma. British Thoracic Society Scottish Intercollegiate Guidelines Network.
        2019 (Available from:) (Accessed: August 2021)
        • Global Initiative for Asthma
        Global strategy for asthma management and prevention - global initiative for asthma report.
        2021 (Available from:) (Accessed: August 2021)
        • Levy M.
        • Andrews R.
        • Buckingham R.
        • et al.
        Why asthma still kills: the National Review of Asthma Deaths (NRAD) Confidential Enquiry report.
        Royal College of Physicians, London, GB2014: 115
        • Lilley A.
        • Turner L.
        Assessing the benefits of having a specialist paediatric pharmacist and physiotherapist in the community to improve childhood asthma outcomes.
        Arch Dis Child. 2016; 101 (e2-e2)
        • Macedo T.M.F.
        • Freitas D.A.
        • Chaves G.S.S.
        • Holloway E.A.
        • Mendonca K.M.P.P.
        Breathing exercises for children with asthma (Cochrane review).
        Cochrane Database Syst Rev. 2016; 4https://doi.org/10.1002/14651858.CD011017.pub2