title: A comparison of assisted cough techniques in stable patients with severe respiratory insufficiency due to amyotrophic lateral sclerosis.
abstract: Cough can be impaired in ALS. This can result in peak cough flows (PCFs) too low for an adequate airway clearance (<270 l/mn). There are several cough assistance techniques that aim at a better elimination of airway secretions, but which are effective, especially in bulbar patients, is not known. We designed the present investigation to compare the PCFs produced by a range of manual and mechanical techniques in patients with ALS, in non-bulbar but also in bulbar patients. In the whole study population, PCFs ranged from 84 (35-118) l/mn for the spontaneous cough manoeuvre to 488 (243-605) l/min for the in/exsufflator (p = 0.0005). In the bulbar group, these values were 42 (35-130) l/min versus 436 (244-630) l/min, respectively (p = 0.008), and 89 (40-106) l/min versus 491 (192-580) l/min, respectively, in the non-bulbar group (p = 0.019). There was no statistically significant difference between the bulbar and the non-bulbar groups. The in/exsufflator was not always the best tool. We conclude that capacity of coughing efforts to produce efficient peak cough flows can be dramatically improved with different tools, even in patients with very severe bulbar symptoms and that it appears useful to test an array of techniques to optimally tailor cough improvement techniques to individual patients.
authors.affiliation: Department of Pneumology, Hospital Universitario San Juan de Alicante, San Juan, Alicante, Spain.
authors.forename: Cristina
authors.initials: C
authors.lastname: Senent
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Golmard
authors.forename: François
authors.initials: F
authors.lastname: Salachas
authors.forename: Eusebi
authors.initials: E
authors.lastname: Chiner
authors.forename: Capucine
authors.initials: C
authors.lastname: Morelot-Panzini
authors.forename: Vincent
authors.initials: V
authors.lastname: Meninger
authors.forename: Catherine
authors.initials: C
authors.lastname: Lamouroux
authors.forename: Thomas
authors.initials: T
authors.lastname: Similowski
authors.forename: Jesus
authors.initials: J
authors.lastname: Gonzalez-Bermejo
mesh_terms: D000368:Aged; D000690:Amyotrophic Lateral Sclerosis / Q000150:complications* / Q000503:physiopathology; D001784:Blood Gas Analysis; D015897:Comorbidity; D003371:Cough; D005260:Female; D006801:Humans; D007327:Insufflation / Q000295:instrumentation; D007385:Intermittent Positive-Pressure Ventilation; D008297:Male; D008875:Middle Aged; D026201:Musculoskeletal Manipulations; D010342:Patient Acceptance of Health Care; D012129:Respiratory Function Tests; D012131:Respiratory Insufficiency / Q000209:etiology / Q000628:therapy*; D012132:Respiratory Muscles / Q000503:physiopathology; D012138:Respiratory Therapy / Q000379:methods*