title: Cough determinants in patients with neuromuscular disease.
abstract: Neuromuscular disease leads to cough impairment. Cough augmentation can be achieved by mechanical insufflation (MI) or manually assisted coughing (MAC). Many studies have compared these two methods, but few have evaluated them in combination. In 155 neuromuscular patients, we assessed determinants of peak cough flow (PCF) using stepwise correlation. Maximal inspiratory capacity contributed 44% of the variance (p<0.001), expiratory reserve volume 13%, and maximal expiratory pressure 2%. Thus, augmenting inspiration seems crucial. However, parameters dependent on expiratory muscles independently influence PCF. We measured vital capacity and PCF in 10 neuromuscular patients during cough augmentation by MI, MAC, or both. MI or MAC significantly improved VC and PCF (p<0.01) as compared to the basal condition and VC and PCF were higher during MI plus MAC than during MAC or MI alone (p<0.01). In conclusion, combining MAC and MI is useful for improving cough in neuromuscular patients.
authors.affiliation: Medical Intensive Care Unit, Physiology and Function Testing Unit/Technological Innovation Center, AP-HP, 92380 Garches, France.
authors.forename: Grégoire
authors.initials: G
authors.lastname: Trebbia
authors.forename: Mathieu
authors.initials: M
authors.lastname: Lacombe
authors.forename: Christophe
authors.initials: C
authors.lastname: Fermanian
authors.forename: Line
authors.initials: L
authors.lastname: Falaize
authors.forename: Michèle
authors.initials: M
authors.lastname: Lejaille
authors.forename: Alain
authors.initials: A
authors.lastname: Louis
authors.forename: Christian
authors.initials: C
authors.lastname: Devaux
authors.forename: Jean Claude
authors.initials: JC
authors.lastname: Raphaël
authors.forename: Frédéric
authors.initials: F
authors.lastname: Lofaso
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D003371:Cough / Q000503:physiopathology* / Q000628:therapy; D005069:Evaluation Studies as Topic; D005260:Female; D005540:Forced Expiratory Flow Rates / Q000502:physiology*; D006801:Humans; D007327:Insufflation / Q000379:methods; D008297:Male; D008875:Middle Aged; D009468:Neuromuscular Diseases / Q000503:physiopathology* / Q000628:therapy; D012043:Regression, Psychology; D012129:Respiratory Function Tests / Q000379:methods; D012131:Respiratory Insufficiency / Q000503:physiopathology; D012138:Respiratory Therapy / Q000379:methods; D012189:Retrospective Studies; D013147:Spirometry / Q000379:methods; D014797:Vital Capacity / Q000502:physiology*