Introduction of domiciliary mechanical insufflation-exsufflation can reduce the incidence of crisis admissions in patients with Duchenne muscular dystrophy (DMD)

Abstract

Although trials are ongoing, there is limited evidence to support the use of mechanical insufflations-exsufflation as a method of secretion clearance to prevent chest infections in patients with DMD. However our local unit practice is to provide a machine to DMD patients that are established on non invasive ventilation with a peak expiratory cough flow < than 160 litres per min despite maximal physiotherapy adjuncts with either: (1) > 2 episodes of chest sepsis per year requiring antibiotics and hospital admission (2) 1 episode of severe chest sepsis requiring invasive ventilation. The aim of the use of the cough assist machine is to reduce the frequency of hospital admissions and length of stay (LOS). We reviewed the prospective data from our DMD patient cohort over a 7 year period in which 32 patients had been issued with a machine. We reviewed the data for 12 months pre and post issue in order to establish the effect on admission frequency and LOS.

These data have showed a significant reduction in both hospital admission frequency and LOS for those patients using a domiciliary cough assist machine. These are the first data to add support to the use of domiciliary cough assist machines in DMD patients with an ineffective cough and previous episodes of chest sepsis already established on NIV.