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Copyright ©ERS Journals Ltd 2003
Cough augmentation with mechanical insufflation/exsufflation in patients with neuromuscular weakness
1 Sleep and Ventilation Unit and 2 Respiratory Muscle Laboratory, Royal Brompton Hospital, London, UK
CORRESPONDENCE: M. Chatwin, Sleep and Ventilation Unit, Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK. Fax: 44 2073518911. E-mail: M.Chatwin@rbh.nthames.nhs.uk
Keywords: noninvasive positive pressure ventilation, paediatrics, physiotherapy, respiratory muscle tests
Received: June 5, 2002
Accepted October 4, 2002
M. Chatwin was funded by a grant from the Jennifer Trust for Spinal Muscular Atrophy, Stratford-upon-Avon, UK. Support for patient expenses was provided by Brompton Breathers Trust Fund, London, UK. E. Ross was funded by the Cystic Fibrosis Trust (Bromley, UK), A.H. Nickol by the British Lung Foundation (London, UK) and N. Hart by the Association Française Contre Les Myopathies (Paris, France).
Adults and children with neuromuscular disease exhibit weak cough and are susceptible to recurrent chest infections, a major cause of morbidity and mortality. Mechanical insufflation/exsufflation may improve cough efficacy by increasing peak cough flow. It was hypothesised that mechanical insufflation/exsufflation would produce a greater increase in peak cough flow than other modes of cough augmentation. The acceptability of these interventions was also compared.
Twenty-two patients aged 10–56 yrs (median 21 yrs) with neuromuscular disease and 19 age-matched controls were studied. Spirometry was performed and respiratory muscle strength measured. Peak cough flow was recorded during maximal unassisted coughs, followed in random order by coughs assisted by physiotherapy, noninvasive ventilation, insufflation and exsufflation, and exsufflation alone. Subjects rated strength of cough, distress and comfort on a visual analogue scale.
In the neuromuscular disease group, mean±sd forced expiratory volume in one second was 0.8±0.6 L·s–1, forced vital capacity 0.9±0.8 L, maximum inspiratory pressure 25±16 cmH2O, maximum expiratory pressure 26±22 cmH2O and unassisted peak cough flow 169±90 L·min–1. The greatest increase in peak cough flow was observed with mechanical insufflation/exsufflation at 235±111 L·min–1 (p<0.01). All techniques showed similar patient acceptability.
Mechanical insufflation/exsufflation produces a greater increase in peak cough flow than other standard cough augmentation techniques in adults and children with neuromuscular disease.
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