Figures
- Fig. 1.—
a, c) Maximal unassisted cough and b, d) insufflation/exsufflation cough in a, b) a control and c, d) a child with neuromuscular disease. a) represents the start of the cough and b) peak cough flow. The two downward spikes are flow artefact. Note the poor inspiration by the paediatric patient (c). Exp.: expiration; Insp.: inspiration; Insuff.: insufflation; Exsuff.: exsufflation.
- Fig. 2.—
Peak cough flow (PCF) in a) paediatric patients, b) paediatric controls, c) adult patients, and d) adult controls. Data are presented as mean±sd. UAC: unassisted cough; PAC: physiotherapy-assisted cough; NVAC: noninvasive ventilator-assisted cough; EAC: exsufflation-assisted cough; IEAC: insufflation/exsufflation-assisted cough. **, ***: p<0.01, p<0.001 versus UAC.
Tables
- Table 1
Patient demographics
Patient Age Diagnosis SNIP P mo,W P I,max P E,max FEV1 FVC FEV1/FVC S p,O2 P ET,CO2 no. yrs cmH2O cmH2O cmH2O cmH2O L L % % kPa Paediatric 1 10 SMA 38.0 40.0 53.2 41.7 1.5 1.7 88.4 98 5.5 2 11 SMA 27.2 25.7 23.7 30.6 0.4 0.4 100.0 95 5.1 3 12 SMA 35.7 15.0 0.2 0.4 50.0 97 5.9 4 14 DMD 21.0 19.0 19.0 16.7 0.4 0.5 73.6 97 5.7 5 17 DMD 10.0 11.2 14.5 9.7 0.4 0.5 72.9 96 4.9 6 15 DMD 18.0 14.6 13.6 15.4 0.4 0.9 44.0 97 6.1 7 14 CMD 29.8 15.1 11.6 7.8 U U 95 5.3 8 16 CMD 19.0 31.7 23.2 15.9 0.4 0.3 106.1 94 6.0 Mean±sd 14±2 24.8±9.5 21.5±10.0 22.7±14.3 19.7±12.2 0.5±0.4 0.7±0.5 76.41±23.63 96±1 5.6±0.4 Adult 9 18 SMA 51.1 18.8 34.6 21.1 1.1 1.2 97.4 97 5.0 10 18 DMD 6.8 6.8 7.5 8.1 0.3 0.3 93.5 94 htvf 11 44 SMA 28.1 55.0 30.8 61.9 2.7 3.3 81.9 97 6.0 12 22 SMA 30.6 37.8 63.0 31.5 1.6 2.0 76.7 97 5.6 13 20 SMA 13.3 11.5 12.6 11.9 U U 94 6.1 14 28 SMA 30.1 16.9 33.3 17.8 0.9 0.9 98.8 97 5.7 15 35 SMA 63.5 20.9 46.8 23.5 1.3 1.4 97.1 98 5.0 16 22 SMA 14.2 11.0 15.5 14.8 0.3 0.4 62.8 98 4.8 17 25 DMD 6.4 4.6 6.9 5.4 0.3 0.5 58.3 96 7.7 18 30 DMD 5.0 4.4 8.9 4.6 U U 98 7.1 19 22 CMD 14.6 20.0 18.3 23.2 0.3 0.4 94.4 94 5.0 20 56 Polio 36.6 65.0 36.3 52.7 0.6 0.9 70.3 94 5.2 21 53 Polio 28.0 53.0 17.5 47.8 0.9 1.0 86.4 96 5.6 22 45 Polio 45.0 111.5 40.5 94.8 0.7 0.9 81.3 96 5.2 Mean±sd 31±13 26.7±17.9 31.2±30.5 26.6±16.8 29.9±25.8 0.9±0.7 1.1±0.9 83.3±13.9 96±2 5.7±0.9 All patients Mean±sd 25±13 26.0±14.8 27.7±24.6 25.3±15.4 26.5±21.9 0.8±0.6 0.9±0.7 80.7±17.3 96±1 5.6±0.7 -
SNIP: sniff nasal inspiratory pressure
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Pmo,W: whistle mouth pressure
-
PI,max: maximal static inspiratory mouth pressure
-
PE,max: maximal static expiratory mouth pressure
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FEV1: forced expiratory volume in one second
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FVC: forced vital capacity
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Sp,O2: arterial oxygen saturation measured by pulse oximetry
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PET,CO2: end-tidal carbon dioxide tension
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SMA: spinal muscular atrophy
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DMD: Duchenne's muscular dystrophy
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CMD: congenital muscular dystrophy
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polio: poliomyelitis
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U: unrecordable
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- Table 2
Control demographics
Patient Age SNIP P mo,W P I,max P E,max FEV1 FVC FEV1/FVC S p,O2 P ET,CO2 no. yrs cmH2O cmH2O cmH2O cmH2O L L % % kPa Paediatric 1 11 65.4 58.3 59.7 31.0 1.4 1.8 78.4 96 5.7 2 10 90.3 100.6 89.0 112.0 1.5 2.0 73.0 96 5.1 3 14 90.0 132.0 90.6 74.7 5.1 6.0 83.9 97 5.3 4 12 105.6 102.5 77.7 78.0 2.6 3.3 78.5 98 5.0 5 14 103.2 70.0 91.3 90.1 2.1 2.8 73.0 98 4.6 6 16 79.0 105.0 125.4 79.1 3.4 3.6 93.3 97 5.1 7 15 104.0 167.7 164.8 123.8 4.5 6.2 72.2 98 5.3 8 17 129.0 170.0 120.0 164.2 2.3 2.7 86.8 97 6.1 Mean±sd 13.6±2.4 95.8±19.2 113.3±41.0 102.3±33.0 94.1±39.6 2.8±1.3 3.5±1.7 79.9±7.6 97±1 5.3±0.4 Adult 9 18 108.0 136.0 120.5 136.0 2.1 2.5 85.7 98 5.3 10 25 101.0 154.2 90.9 120.6 3.8 4.5 84.0 98 11 44 116.0 151.0 98.6 108.6 3.0 4.7 65.4 96 5.2 12 22 130.0 208.0 149.8 157.2 4.9 6. 69.0 69.8 98 13 22 67.0 95.0 48.3 85.5 3.3 3.8 88.3 99 4.8 14 20 118.6 256.0 116.0 181.0 4.2 5.9 70.9 98 5.7 15 18 95.0 114.0 86.1 83.9 3.4 3.7 91.8 99 4.5 16 30 114.5 152.6 161.7 177.5 3.8 4.0 77.3 98 4.0 17 28 43.8 147.2 112.6 125.3 3.5 4.2 83.2 98 18 35 56.1 78.5 72.1 64.2 3.4 4.3 79.1 97 5.8 19 22 65.2 104.5 81.8 92.4 3.2 3.4 93.6 98 4.5 Mean±sd 26±8 92.3±29.2 145.2±51.1 103.5±33.2 121.1±39.0 3.5±0.7 4.4±1.2 80.8±9.2 98±1 5.1±0.5 All controls Mean±sd 21±9 93.8±24.9 131.7±48.6 103.0±32.2 109.7±40.5 3.2±1.0 4.0±1.5 80.4±8.4 98±1 5.2±0.5 -
SNIP: sniff nasal inspiratory pressure
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Pmo,W: whistle mouth pressure
-
PI,max: maximal static inspiratory mouth pressure
-
PE,max: maximal static expiratory mouth pressure
-
FEV1: forced expiratory volume in one second
-
FVC: forced vital capacity
-
Sp,O2: arterial oxygen saturation measured by pulse oximetry
-
Pet,co2: end-tidal carbon dioxide tension
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