Effect of Lung Volume Recruitment on Pulmonary Function in Progressive Childhood-Onset Neuromuscular Disease: A Systematic Review.

Children and young people with progressive neuromuscular diseases often lose lung capacity and cough strength over time, which raises concerns about respiratory complications. This review looked at whether a technique called lung volume recruitment, which uses manual resuscitator bags or volume-controlled ventilators to stack breaths and expand the lungs, affects measures of lung function in this group. After searching several databases, the reviewers found only nine relevant studies, and just six were judged strong enough to include. Pooling what evidence existed, they found some suggestion that lung volume recruitment has an immediate benefit for cough strength, plus a possible longer-term slowing of the decline in vital capacity.

However, the authors describe this evidence as limited, based on small studies, and call for larger controlled trials before firmer conclusions can be drawn.

If you or your child has a progressive neuromuscular condition, you may have heard about breathing exercises designed to help the lungs stay as strong as possible for as long as possible. This review looked specifically at a technique called lung volume recruitment, which uses a bag or ventilator to help stretch the lungs beyond a normal breath, and asked whether it actually helps. The researchers combined findings from a small group of studies, only six of which were considered good enough quality to include.

They found some evidence that the technique can give an immediate boost to cough strength, which matters because a strong cough helps clear mucus from the airways. There was also a hint that it might slow the gradual decline in lung capacity over time, though this is less certain. The main thing to keep in mind is how small and limited this evidence base is.

The authors themselves say larger, better-designed trials are needed before anyone can be confident about the real benefit.

This is a summary of research, not medical advice. Talk to your own healthcare provider about anything affecting your care.

For physiotherapists managing respiratory care in childhood-onset neuromuscular disease, a recurring clinical question is whether lung volume recruitment, delivered via manual resuscitator bag or volume-controlled ventilator, meaningfully alters pulmonary function trajectories once forced vital capacity begins to fall. This systematic review searched six databases and identified only nine relevant studies, with just six meeting the quality bar for inclusion after Joanna Briggs Institute critical appraisal, underscoring how thin the evidence base currently is. The narrative synthesis points to an immediate effect on peak cough flow and a potential effect on slowing the rate of forced vital capacity decline over time, which is clinically relevant given the established association between forced vital capacity and morbidity in this population.

However, these are described as limited findings drawn from small samples, not robust, pooled effect estimates, so they should inform clinical reasoning about when lung volume recruitment might be considered as forced vital capacity deteriorates rather than establish a proven treatment effect. The review does not establish optimal dosing, timing, or which specific patient subgroups benefit most, and the authors explicitly call for larger controlled trials. Adverse events are not reported in the abstract, so no safety conclusions can be drawn from this synthesis.