A Review on Cough Augmentation Techniques: Assisted Inspiration, Assisted Expiration and Their Combination

Abstract

Cough is an important mechanism of airway clearance. In patients who present weak and ineffective cough, augmentation techniques aim to assist or simulate the maneuver. These techniques target different phases of the cough cycle, mainly the inspiratory and expiratory phases, through assisted inspiration, assisted expiration and their combination. They include the manual hyperinflation, ventilator hyperinflation, glossopharyngeal breathing, manually assisted cough and mechanical insufflator-exsufflator, each applied individually or in different combinations. The aim of this review is to investigate the effectiveness and safety of cough augmentation techniques. Findings support that all commonly used techniques can theoretically improve airway clearance, as they generate higher cough peak flows compared to unassisted cough. Still, the studies assessing cough augmentation present considerable limitations and the direct comparison of different techniques is challenging. Current evidence indicate that cough peak flow shows higher increase with the combination of assisted inspiration and expiration, and improvement is greater in patients with lower unassisted values. Associated adverse events are infrequent.

Recommendations for outpatient respiratory rehabilitation of long COVID patients

“…En la tabla 3 se detallan las diferentes técnicas de drenaje bronquial [55][56][57][58][59][60][61][62][63] , entre las que se encuentran las manuales y las instrumentales. Aunque durante muchos años se han utilizado técnicas como el drenaje postural, o técnicas manuales como el clapping y las vibraciones, la evidencia científica actual indica que, aunque sí puedan tener algún efecto beneficioso, las técnicas activas por parte del paciente donde se trabaja a diferentes volúmenes y flujos podrían tener mayores beneficios y mayor adherencia al tratamiento 64,65 .…”

“…Pacientes colaboradores. Se podría asistir además con AMBU 60 . Técnicas instrumentales de drenaje Cough Assist Útiles en pacientes con patología previa restrictiva.…”

Locked‐In Syndrome: Practical Rehabilitation Management

“…The prevention and treatment of atelectasis are best achieved using a mechanical insufflator-exsufflator, also known as a cough assist (CA). 18 This modality can be given via tracheostomy or face mask if air leaking can be prevented. The CA works by delivering high pressure air to inflate the lungs followed by a rapid negative pressure to facilitate lung deflation, acting like a mechanical cough or high velocity sigh.…”

“…The prevention and treatment of atelectasis are best achieved using a mechanical insufflator‐exsufflator, also known as a cough assist (CA) 18 . This modality can be given via tracheostomy or face mask if air leaking can be prevented.…”

A combination effect of manual assisted cough techniques and respiratory proprioceptive neuromuscular facilitation on ventilatory decompression craniotomy patients: a case report

“…The two phases of cough cycle mainly the inspiratory and expiratory phase is targeted by these techniques through assisted inspiration, assisted expiration and combination of both referred to as MACT. 8,9 To facilitate chest wall mobility and to improve chest wall expansion, respiratory proprioceptive neuromuscular facilitation (PNF) is used. By the word it helps in facilitating mobility of thoracic cage there by in initiation of coordination, stability and control movements of chest wall.…”