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Osteopathic Manipulative Medicine Use in Pediatric Patients With Pertussis

Tami Hendriksz, DO; Stacey Pierce-Talsma, DO

From the Touro University ertussis, or whooping cough, is a severe, tion at or near the diaphragm’s attachments, College of Osteopathic potentially life-threatening disease caused including ribs 6-12, lumbar vertebrae L1-3, and Medicine-CA in Vallejo. P by the bacteria Bordetella pertussis and is the xiphoid process.7 The cervical spine may also Financial Disclosures: one of the most prevalent vaccine-preventable be assessed, as the diaphragm receives its innerv- None reported. diseases in the United States.1 The classic presen- ation from the phrenic nerve (C3-C5). The occipi- Support: This video was tation of pertussis occurs in unvaccinated children toatlantal region (OA) may also be assessed, as produced by Touro University younger than 10 years who develop paroxysms of vagus nerve afferents and efferents are an integral College of Osteopathic fl 8 Medicine-CA. cough followed by forced inspiratory efforts part of the cough re ex. Paroxysms of coughing (a whoop) and posttussive emesis.2 The coughing may lead to somatic dysfunction of any of these Address correspondence to Tami Hendriksz, DO, Touro spells may lead to gagging, apnea, and cyanosis. listed areas, among others. University College of Older children and adults often experience mild The video demonstrates the balanced ligament- Osteopathic Medicine-CA, or asymptomatic disease. Continued outbreaks of ous tension technique of the thoracic diaphragm, 1310 Club Dr, Mare Island, pertussis may be due to several factors, including which is a passive technique and may be used for Vallejo, CA 94592-1187. lower vaccination rates, waning immunity in previ- an infant or child with pertussis.9 Email: [email protected] ously vaccinated adolescent and adult populations, Contraindications to this type of assessment and Submitted and genetic changes in the circulating strains of treatment include lower rib or vertebral fractures, November 30, 2018; pertussis.3,4 as well as malignant neoplasm, open wounds, inci- accepted January 8, 2019. Supportive care is the mainstay of management sions, or infection in the areas where the physi- for pertussis, although antimicrobial treatment cian’s hands are placed. Successful treatment with macrolides is recommended early in the should optimize respiratory biomechanics while course of the disease (within 7 days of the onset) facilitating venous and lymphatic return.6,7 This and in high-risk individuals (such as infants and technique can be used with patients of all ages pregnant women).5 Prevention includes postexpo- with pertussis (and other respiratory illnesses), sure antimicrobial prophylaxis for all household including newborns and infants, who are the and close contacts and age-appropriate immuniza- most vulnerable. Assessing and treating the tion against pertussis. diaphragm in patients with illnesses like pertussis Symptomatic therapies such as bronchodilators, may aid in symptomatic and physiologic improve- corticosteroids, antitussive agents, and antihista- ment.6 (doi:10.7556/jaoa.2019.021) mines have not proven to be effective for pertussis- related cough.5 Osteopathic manipulative treatment Acknowledgments (OMT) offers a potentially useful adjuvant to Special thanks to Jeff Reedy for contributions in video the traditional supportive care that is provided to production and editing, Lee Ann Cuny, DO, and our model, patients with pertussis. Understanding the Vivianna Nuño. anatomy and neuropathophysiologic process of the cough reflex helps identify key areas that may References be evaluated and treated with OMT. The dia- 1. Mooi FR, Van Der Maas NA, De Melker HE. Pertussis phragm may be assessed, as it is the main muscle resurgence: waning immunity and pathogen adaptation—two of respiration and facilitates venous and lymphatic sides of the same coin. Epidemiol Infect. 2014;142(4):685-694. doi:10.1017/S0950268813000071 return.6 Diaphragmatic dysfunction can occur as a 2. Cherry JD, Tan T, Wirsing von König CH, et al. Clinical definitions primary dysfunction or as the result of a dysfunc- of pertussis: summary of a Global Pertussis Initiative roundtable

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meeting, February 2011. Clin Infect Dis. 2012;54(12):1756-1764. 6. Bordoni B, Marelli F, Morabito B, Sacconi B. Manual evaluation doi:10.1093/cid/cis302 of the diaphragm muscle. Int J Chron Obstruct Pulmon Dis. 2016;11:1949-1956. doi:10.2147/COPD.S111634 3. Phadke VK, Bednarczyk RA, Salmon DA, Omer SB. Association between vaccine refusal and vaccine-preventable diseases in the 7. Sergueef N. Cranial Osteopathy for Infants, Children and Adolescents: United States: a review of measles and pertussis [published correction A Practical Handbook. Churchill Livingston; 2007. appears in JAMA. 2016;315(19):2125]. JAMA. 2016;315 8. Polverino M, Polverino F, Fasolino M, Andò F, Alfieri A, De Blasio F. (11):1149-1158. doi:10.1001/jama.2016.1353 Anatomy and neuro-pathophysiology of the cough reflex arc. Multidiscip 4. Centers for Disease Control and Prevention (CDC). Pertussis epidemic— Respir Med. 2012;7(1):5. doi:10.1186/2049-6958-7-5 Washington, 2012. MMWR Morb Mortal Wkly Rep. 2012;61(28):517-522. 9. Carreiro JE. The spine, rib cage, and sacrum. In: Carreiro JE. Pediatric 5. Kilgore PE, Salim AM, Zervos MJ, Schmitt HJ. Pertussis: microbiology, Manual Medicine: An Osteopathic Approach. Churchill Livingston; disease, treatment, and prevention. Clin Microbiol Rev. 2016;29 2009:99-154. doi:10.1016/B978-0-443-10308-7.00003-X (3):449-486. doi:10.1128/CMR.00083-15 © 2019 American Osteopathic Association

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