| Thorax. 2001 June; 56(6): 438–444. doi: 10.1136/thorax.56.6.438. | PMCID: PMC1746077 |
Effect of manually assisted cough and mechanical insufflation on
cough flow of normal subjects, patients with chronic obstructive
pulmonary disease (COPD), and patients with respiratory muscle weakness P Sivasothy, L Brown, I Smith, and J Shneerson Respiratory Support and Sleep Centre, Papworth Hospital, Papworth Everard, Cambridge CB3 8RE, UK. Email: ps247/at/cus.cam.ac.uk Abstract BACKGROUND—It has been
suggested that cough effectiveness can be improved by assisted
techniques. The effects of manually assisted cough and mechanical
insufflation on cough flow physiology are reported in this study. METHODS—The
physiological actions and patient self-assessment of manually assisted
cough and mechanical insufflation were investigated in 29 subjects
(nine normal subjects, eight patients with chronic obstructive
pulmonary disease (COPD), four subjects with respiratory muscle
weakness (RMW) with scoliosis, and eight subjects with RMW without scoliosis). RESULTS—The peak cough
expiratory flow rate and cough expiratory volume were not improved by
manually assisted cough and mechanical insufflation alone or in
combination in normal subjects. The median increase in peak cough
expiratory flow in subjects with RMW without scoliosis with manually
assisted cough alone or in combination with mechanical insufflation of
84 l/min (95% confidence interval (CI) 19 to 122) and 144 l/min
(95% CI 14 to 195), respectively, reflects improvement in the
expulsive phase of coughing by these techniques. Manually assisted
cough and mechanical insufflation in combination raised peak expiratory
flow rate more than either technique alone in this group. The abnormal
chest shape in scoliotic subjects and the fixed inspiratory pressure
used made effective manually assisted cough and mechanical insufflation
difficult in this group and no improvements were found. In patients
with COPD manually assisted cough alone and in combination with
mechanical insufflation decreased peak expiratory flow rate by
144 l/min (95% CI 25 to 259) and 135 l/min (95% CI 30 to 312), respectively. CONCLUSIONS—Manually
assisted cough and mechanical insufflation should be considered to
assist expectoration of secretions in patients with RMW without
scoliosis but not in those with scoliosis. Full Text The Full Text of this article is available as a PDF (129K). These references are in PubMed. This may not be the complete list of references from this article. - Hanayama, K; Ishikawa, Y; Bach, JR. Amyotrophic lateral sclerosis. Successful treatment of mucous plugging by mechanical insufflation-exsufflation. Am J Phys Med Rehabil. 1997 76(4):338–339.Jul–Aug; [PubMed]
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