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A Comparison of Cough Assistance Techniques in Patients with Respiratory Muscle Weakness

 Sun Mi Kim  ;  Won Ah Choi  ;  Yu Hui Won  ;  Seong-Woong Kang 
 YONSEI MEDICAL JOURNAL, Vol.57(6) : 1488-1493, 2016 
Journal Title
Issue Date
Adolescent ; Adult ; Aged ; Cough* ; Cross-Over Studies ; Female ; Humans ; Insufflation/instrumentation* ; Insufflation/methods ; Insufflation/statistics & numerical data ; Male ; Middle Aged ; Neuromuscular Diseases/physiopathology* ; Peak Expiratory Flow Rate/physiology ; Pressure ; Respiratory Function Tests/instrumentation ; Respiratory Function Tests/methods ; Respiratory Muscles/physiopathology* ; Respiratory Therapy/methods* ; Treatment Outcome ; Vital Capacity/physiology
Neuromuscular disease ; cough augmentation ; mechanical in-exsufflator ; peak cough flow
PURPOSE: To assess the ability of a mechanical in-exsufflator (MI-E), either alone or in combination with manual thrust, to augment cough in patients with neuromuscular disease (NMD) and respiratory muscle dysfunction. MATERIALS AND METHODS: For this randomized crossover single-center controlled trial, patients with noninvasive ventilator-dependent NMD were recruited. The primary outcome was peak cough flow (PCF), which was measured in each patient after a cough that was unassisted, manually assisted following a maximum insufflation capacity (MIC) maneuver, assisted by MI-E, or assisted by manual thrust plus MI-E. The cough augmentation techniques were provided in random order. PCF was measured using a new device, the Cough Aid. RESULTS: All 40 enrolled participants (37 males, three females; average age, 20.9±7.2 years) completed the study. The mean (standard deviation) PCFs in the unassisted, manually assisted following an MIC maneuver, MI-E-assisted, and manual thrust plus MI-E-assisted conditions were 95.7 (40.5), 155.9 (53.1), 177.2 (33.9), and 202.4 (46.6) L/min, respectively. All three interventions significantly improved PCF. However, manual assistance following an MIC maneuver was significantly less effective than MI-E alone. Manual thrust plus MI-E was significantly more effective than both of these interventions. CONCLUSION: In patients with NMD and respiratory muscle dysfunction, MI-E alone was more effective than manual assistance following an MIC maneuver. However, MI-E used in conjunction with manual thrust improved PCF even further.
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1. College of Medicine (의과대학) > Dept. of Rehabilitation Medicine (재활의학교실) > 1. Journal Papers
Yonsei Authors
Kang, Seong Woong(강성웅) ORCID logo https://orcid.org/0000-0002-7279-3893
Choi, Won Ah(최원아) ORCID logo https://orcid.org/0000-0003-0403-8869
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