Acute and chronic effects of mechanical insufflation-exsufflation in patients with neuromuscular disease

Abstract

Purpose: Neuromuscular disease affects pulmonary function, respiratory muscle strength, and peak cough flow. The aim of study was to compare acute and chronic effects of mechanical insufflation-exsufflation (MI-E) in patients with neuromuscular disease.

Material and Methods: Eight children (6M, 2F, 12.5±5.5 years) with neuromuscular disease participated in the study. All of patients were treated with MI-E a total of 15 sessions for airway clearance. Before and after the first session and at the end of 15 sessions, pulmonary function testing was performed and respiratory muscle strength (maximal inspiratory pressure [MIP], maximal expiratory pressure [MEP], respiratory muscle endurance [35% of MIP], sniff nasal inspiratory pressure), and peak cough flow rate (PCF) were measured. The respiratory dysfunction was evaluated with Pulmonary Dysfunction Index. Friedman analysis was used to compare the variables.

Results: The FEF_25-75%, PCF and respiratory muscle endurance were significantly increased at the end of the first session (p<0.05). The FEV₁, FEV₁/FVC, FEF_25-75%, MIP, MIP%, MEP, MEP%, sniff pressure, PCF, and respiratory muscle endurance were significantly increased at the end of 15 sessions as compared with baseline and first treatment (p<0.05).

Discussion: Peak cough flow, respiratory muscle endurance and small airways' function improved after only one session of training with MI-E. Long term training with MI-E is need to augmentation of cough and increasing of respiratory muscle strength.