Accuracy in the Assessment of Cough Peak Flow: Good Progress for a “Work in Progress”

Kulnik, Stefan Tino; Lewko, Agnieszka; MacBean, Victoria; Spinou, Arietta

doi:10.4187/respcare.07454

Cited by 6 publications

(5 citation statements)

References 10 publications

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“…how quickly the measurement device can respond to an instantaneous full-scale flow change. 13 For this reason, we compared four different MI-E devices with the same pneumotachograph that was connected to a high frequency response pressure transducer. We also performed paired comparisons of CPF values measured at the mouth by the devices in collapsing and non-collapsing conditions, independently from the MI-E device used.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Four Mechanical Insufflation-Exsufflation Devices: Effect of Simulated Airway Collapse on Cough Peak Flow

et al. 2023

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Background: Mechanical insufflation-exsufflation (MI-E) devices are used to improve airway clearance in individuals with acute respiratory failure. Some MI-E devices measure cough peak flow (CPF) during MI-E to optimize pressure adjustments.The aim was to compare CPF and effective cough volume (ECV: volume expired/coughed above 3 L/sec) measurements between four MI-E devices under simulated conditions of stable versus collapsed airway.Methods: Four MI-E devices were tested on the bench. Each device was connected via a standard circuit to a collapsible tube placed in an airtight chamber that was attached to a lung model with adjustable compliance and resistance. Pressure was measured upstream and downstream the collapsing tube; airflow was measured between the chamber and the lung model. Each device was tested in two conditions: collapse condition (0 cmH 2 O) and nocollapse condition (-70 cmH 2 O). For each condition, 6 combinations of inspiratory/expiratory pressures were applied. CPF was measured at the "mouth level" by the device built-in flow meter and at the "tracheal level" by a dedicated pneumotachograph.Comparisons were performed with non-parametric tests.Results: CPF values measured at the "tracheal level" and ECV values differed between devices for each inspiratory/expiratory pressure in the collapse and no-collapse conditions (P<.0001). CPF values were significantly lower at the "tracheal" level in the collapse as compared with the no-collapse condition (P<.0001 for each device), whereas they were higher at the "mouth" level (P<.05) for three of the four devices.Conclusions: CPF values differed significantly across MI-E devices, highlighting limitation(s) of using only CPF values to determine cough effectiveness: in situations of airway collapse, CPF increases at the "mouth" whereas it decreases at the "tracheal" level.

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Section: Discussionmentioning

confidence: 99%

Comparison of Four Mechanical Insufflation-Exsufflation Devices: Effect of Simulated Airway Collapse on Cough Peak Flow

et al. 2023

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“…8 Guidelines for judging the usability of CPF measurements, on the other hand, are not as robust. 9 Further complication exists in the lack of standard measurement technology for CPF, with dispute about the accuracy of commonly used peak flow meters against the goldstandard laboratory pneumotachograph. In patients with neuromuscular disorders, the limits of agreement between these devices have been shown to range from 66 to 338 L/min, 9 placing the limits of agreement of CPS within this range.…”

mentioning

confidence: 99%

“…In a process recently navigated by the home‐spirometry industry, standards issued by the American Thoracic Society (ATS) and the European Respiratory Society (ERS) provided guidance on within‐measurement usability and between‐measurement repeatability of forced vital capacity assessment 8 . Guidelines for judging the usability of CPF measurements, on the other hand, are not as robust 9 . Further complication exists in the lack of standard measurement technology for CPF, with dispute about the accuracy of commonly used peak flow meters against the gold‐standard laboratory pneumotachograph.…”

mentioning

confidence: 99%

“…Further complication exists in the lack of standard measurement technology for CPF, with dispute about the accuracy of commonly used peak flow meters against the gold‐standard laboratory pneumotachograph. In patients with neuromuscular disorders, the limits of agreement between these devices have been shown to range from 66 to 338 L/min, 9 placing the limits of agreement of CPS within this range. Recasens et al follow the most recent guidance from the ERS for how often the test should be repeated (3–6 maneuvers), and the requirements for between‐test repeatability (5%) 10 .…”

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confidence: 99%

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Turning up the volume on neuromuscular cough medicine

Geronimo

2023

Muscle and Nerve

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“…It is important that the problem of inaccuracy in the measurement of peak cough flow is highlighted in the literature, especially for clinical audiences who may not be familiar with advantages and disadvantages of different statistical analysis methods. Our group have recently published a letter, in which we have summarised the available evidence of inaccuracy in the measurement of peak cough flow when different instruments are used; and we have argued the clinical importance of making apparent the magnitudes of differences in absolute measurements [4]. I would encourage Tabor-Grey, Vasilopoulos and Plowman to provide this type of analysis to readers, as their data will make a valuable contribution to this field of research.…”

mentioning

confidence: 99%

Comment on ‘Concordant Validity of a Digital Peak Cough Flow Meter to Assess Voluntary Cough Strength in Individuals with ALS’

Kulnik

2020

Dysphagia

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I read with interest the recent publication by Tabor-Grey, Vasilopoulos and Plowman in Dysphagia [1]. The authors compared volitional peak cough flow measurements obtained with a handheld digital peak flow meter (PF100, Microlife) against measurements obtained with a laboratory system with Lilly type pneumotachograph (MLT1000L, ADInstruments). The purpose was to examine concordance between the measurements, based on the hypothesis that the more convenient and inexpensive handheld device could substitute the laboratory pneumotachograph system. Data from 109 participants with amyotrophic lateral sclerosis (ALS) were analysed using paired t-test (showing no significant difference in group means), Pearson's correlation coefficient (r=0.826, p<0.001), and Lin's concordance correlation coefficient (p c =0.824). The authors' interpretation of these statistics is that these demonstrate 'high reproducibility and agreement between devices' and support the use of the handheld flow meter in individuals with ALS [1].

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Accuracy in the Assessment of Cough Peak Flow: Good Progress for a “Work in Progress”

Cited by 6 publications

References 10 publications

Comparison of Four Mechanical Insufflation-Exsufflation Devices: Effect of Simulated Airway Collapse on Cough Peak Flow

Comparison of Four Mechanical Insufflation-Exsufflation Devices: Effect of Simulated Airway Collapse on Cough Peak Flow

Turning up the volume on neuromuscular cough medicine

Comment on ‘Concordant Validity of a Digital Peak Cough Flow Meter to Assess Voluntary Cough Strength in Individuals with ALS’

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