A review on cough augmentation techniques: Assisted inspiration, assisted expiration and their combination

TY - JOUR

T1 - A review on cough augmentation techniques

T2 - Assisted inspiration, assisted expiration and their combination

AU - Spinou, Arietta

PY - 2020/3/1

Y1 - 2020/3/1

N2 - 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.

AB - 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.

KW - Airway clearance

KW - Cough assist

KW - Cough augmentation

KW - Hyperinflation

KW - Manually assisted cough

KW - Mechanical insufflator-exsufflator

UR - http://www.scopus.com/inward/record.url?scp=85082792119&partnerID=8YFLogxK

U2 - 10.33549/physiolres.934407

DO - 10.33549/physiolres.934407

M3 - Review article

C2 - 32228015

AN - SCOPUS:85082792119

SN - 0862-8408

VL - 69

SP - S93-S103

JO - Physiological Research

JF - Physiological Research

ER -