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Cough augmentation with mechanical insufflation/exsufflation in patients with neuromuscular weakness

M. Chatwin, E. Ross, N. Hart, A.H. Nickol, M.I. Polkey, A.K. Simonds
European Respiratory Journal 2003 21: 502-508; DOI: 10.1183/09031936.03.00048102
M. Chatwin
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E. Ross
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N. Hart
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A.H. Nickol
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M.I. Polkey
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A.K. Simonds
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Figures

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  • Fig. 1.—
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    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.—
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    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

  • Figures
  • Table 1

    Patient demographics

    PatientAgeDiagnosisSNIP P mo,W P I,max P E,max FEV1FVCFEV1/FVC S p,O2 P ET,CO2
    no.yrs cmH2OcmH2OcmH2OcmH2OLL%%kPa
    Paediatric
    110SMA38.040.053.241.71.51.788.4985.5
    211SMA27.225.723.730.60.40.4100.0955.1
    312SMA35.715.00.20.450.0975.9
    414DMD21.019.019.016.70.40.573.6975.7
    517DMD10.011.214.59.70.40.572.9964.9
    615DMD18.014.613.615.40.40.944.0976.1
    714CMD29.815.111.67.8UU955.3
    816CMD19.031.723.215.90.40.3106.1946.0
    Mean±sd14±224.8±9.521.5±10.022.7±14.319.7±12.20.5±0.40.7±0.576.41±23.6396±15.6±0.4
    Adult
    918SMA51.118.834.621.11.11.297.4975.0
    1018DMD6.86.87.58.10.30.393.594htvf
    1144SMA28.155.030.861.92.73.381.9976.0
    1222SMA30.637.863.031.51.62.076.7975.6
    1320SMA13.311.512.611.9UU946.1
    1428SMA30.116.933.317.80.90.998.8975.7
    1535SMA63.520.946.823.51.31.497.1985.0
    1622SMA14.211.015.514.80.30.462.8984.8
    1725DMD6.44.66.95.40.30.558.3967.7
    1830DMD5.04.48.94.6UU987.1
    1922CMD14.620.018.323.20.30.494.4945.0
    2056Polio36.665.036.352.70.60.970.3945.2
    2153Polio28.053.017.547.80.91.086.4965.6
    2245Polio45.0111.540.594.80.70.981.3965.2
    Mean±sd31±1326.7±17.931.2±30.526.6±16.829.9±25.80.9±0.71.1±0.983.3±13.996±25.7±0.9
    All patients
    Mean±sd25±1326.0±14.827.7±24.625.3±15.426.5±21.90.8±0.60.9±0.780.7±17.396±15.6±0.7
    • SNIP: sniff nasal inspiratory pressure

    • 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

    • SMA: spinal muscular atrophy

    • DMD: Duchenne's muscular dystrophy

    • CMD: congenital muscular dystrophy

    • polio: poliomyelitis

    • U: unrecordable

  • Table 2

    Control demographics

    PatientAgeSNIP P mo,W P I,max P E,max FEV1FVCFEV1/FVC S p,O2 P ET,CO2
    no.yrscmH2OcmH2OcmH2OcmH2OLL%%kPa
    Paediatric
    11165.458.359.731.01.41.878.4965.7
    21090.3100.689.0112.01.52.073.0965.1
    31490.0132.090.674.75.16.083.9975.3
    412105.6102.577.778.02.63.378.5985.0
    514103.270.091.390.12.12.873.0984.6
    61679.0105.0125.479.13.43.693.3975.1
    715104.0167.7164.8123.84.56.272.2985.3
    817129.0170.0120.0164.22.32.786.8976.1
    Mean±sd13.6±2.495.8±19.2113.3±41.0102.3±33.094.1±39.62.8±1.33.5±1.779.9±7.697±15.3±0.4
    Adult
    918108.0136.0120.5136.02.12.585.7985.3
    1025101.0154.290.9120.63.84.584.098
    1144116.0151.098.6108.63.04.765.4965.2
    1222130.0208.0149.8157.24.96.69.069.898
    132267.095.048.385.53.33.888.3994.8
    1420118.6256.0116.0181.04.25.970.9985.7
    151895.0114.086.183.93.43.791.8994.5
    1630114.5152.6161.7177.53.84.077.3984.0
    172843.8147.2112.6125.33.54.283.298
    183556.178.572.164.23.44.379.1975.8
    192265.2104.581.892.43.23.493.6984.5
    Mean±sd26±892.3±29.2145.2±51.1103.5±33.2121.1±39.03.5±0.74.4±1.280.8±9.298±15.1±0.5
    All controls
    Mean±sd21±993.8±24.9131.7±48.6103.0±32.2109.7±40.53.2±1.04.0±1.580.4±8.498±15.2±0.5
    • SNIP: sniff nasal inspiratory pressure

    • 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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Cough augmentation with mechanical insufflation/exsufflation in patients with neuromuscular weakness
M. Chatwin, E. Ross, N. Hart, A.H. Nickol, M.I. Polkey, A.K. Simonds
European Respiratory Journal Mar 2003, 21 (3) 502-508; DOI: 10.1183/09031936.03.00048102

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Cough augmentation with mechanical insufflation/exsufflation in patients with neuromuscular weakness
M. Chatwin, E. Ross, N. Hart, A.H. Nickol, M.I. Polkey, A.K. Simonds
European Respiratory Journal Mar 2003, 21 (3) 502-508; DOI: 10.1183/09031936.03.00048102
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