Non-pharmacological techniques for the extremes of the cough spectrum

Abstract

Cough can be viewed as a continuum where extremes represent disease phenotypes. Under this unified concept, non-pharmacological treatment for the extremes of the cough spectrum includes both cough augmentation and cough control techniques. Supporting the cough motor output and exercising the cognitive control on coughing are the main directions of these techniques. Cough augmentation can be provided to patients who present low ability to generate adequate peak cough flows, with the aim to develop the sheering forces that are essential for effective airway clearance. On the other hand, individuals with high cough sensitivity or frequency can practice techniques for cough control, which incorporates a combination of education, retraining and psychological support. These techniques aim to empower patients to increase their supramedulary control on cough. Although hypotheses that are generated by the physiology of cough can support most non-pharmacological techniques, their exact mechanisms of effectiveness remain unclear.

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

“…Cough augmentation techniques that target the inspiratory phase of cough include the manual hyperinflation, ventilator hyperinflation and glossopharyngeal breathing (Chatwin et al 2018). Manual hyperinflation, bagging or breath stacking aims to increase the inspiratory volume and ultimately result in higher expiratory airflow at the expulsive phase of cough (Paulus et al 2012, Spinou 2018. Bagging involves delivering an inspiratory volume to the patient during inspiration, usually until maximum insufflation capacity, at a low inspiratory flow, with an inspiratory pause and then quick release to provide a high expiratory flow (Paulus et al 2012).…”

“…Their aim is to support the expiratory phase of cough to generate an expiratory flow bias and achieve mucus mobilization based on the two-phase gas-liquid interaction (Spinou 2018). MAC uses external mechanical force or compression applied on the thoracic, abdominal, and thoraco-abdominal areas during expiration (Sivasothy et al 2001, Spinou 2018. The technique is applied by therapists, carers or patients who use self-assistance (Bianchi et al 2014, Kan et al 2018.…”

“…Still, on the opposite side of this spectrum, cough can be absent, weak and inadequate to clear the airways (Spinou 2018). When it does not generate effective airflows to achieve airway clearance, cough augmentation techniques can support one or more of the cough inspiratory, compressive, and expiratory phases (McCool 2006, Spinou 2018. These techniques are categorized into assisted inspiration, assisted expiration, or a combination of assisted inspiration and expiration, and include the manual hyperinflation, ventilator hyperinflation, glossopharyngeal breathing, manually assisted cough (MAC) and mechanical insufflatorexsufflator (MI-E), each applied individually or in different combinations (Chatwin et al 2018).…”

Could reflex cough induced through nebulized capsaicin achieve airway clearance in patients with acute retention of lung secretions?

“…(2) If there is hypersecretion, cough becomes an increasingly important additional mechanism for clearing secretions from the lower airways (8,10).…”

“…NTS is most commonly performed by physiotherapists and nurses, as a last-resort treatment when alternative, non-invasive and non-pharmacological modalities for secretion clearance have been unsuccessful (4,5). Examples for commonly applied non-invasive non-pharmacological treatments for secretion clearance are positioning, mobilisation, manually assisted cough, intermittent positive pressure breathing, and mechanical insufflation-exsufflation (2)(3)(4)(5)7,8). For the purpose of this paper, NTS refers to the insertion of a flexible suction catheter (typically around 50 cm in length and with a diameter of 2-6 mm, e.g.…”