title: Cough Augmentation in Subjects With Duchenne Muscular Dystrophy: Comparison of Air Stacking via a Resuscitator Bag Versus Mechanical Ventilation.
abstract: BACKGROUND
  Air stacking improves cough effectiveness in people with Duchenne muscular dystrophy (DMD) and respiratory muscle weakness. However, it is not known whether air stacking is more effective via a resuscitator bag or a home ventilator.
  
  
  METHODS
  This prospective randomized study investigated the effect of air stacking via a volume-cycled home ventilator versus via a resuscitator bag in participants with DMD. Maximum insufflation capacity and peak expiratory flow during spontaneous (cough peak flow) and air stacking-assisted cough maneuvers (air stacking-assisted cough peak flow) were measured.
  
  
  RESULTS
  Fifty-two adult DMD subjects receiving noninvasive ventilation were included in the study: 27 participants performed air stacking via their home ventilator (home-ventilator group; age = 25.3 ± 5.1 y; forced vital capacity (FVC) = 809 ± 555 mL), and 25 participants used a resuscitator bag (resuscitator-bag group; age = 24.7 ± 5.7 y, FVC = 807 ± 495 mL). Following a single training session, air stacking could be performed successfully by 89% (home ventilator) and 88% (resuscitator bag) of participants. There were comparable maximum insufflation capacities (1,481 mL for the home-ventilator group vs 1,344 mL for the resuscitator-bag group, P = .33) and mean air stacking-assisted cough peak flow values (199 L/min for the home-ventilator group vs 186 L/min for the resuscitator-bag group, P = .33) between techniques. Air stacking-assisted cough peak flow increased significantly compared with baseline in both groups (mean increase: +51% [home ventilator] vs +49% [resuscitator bag], P < .001), with individual air stacking-assisted cough peak flow improvements ranging from -20 to 245%.
  
  
  CONCLUSIONS
  Cough augmentation is an important component of the respiratory management of people with a neuromuscular disorder. No difference in cough effectiveness as measured by air stacking-assisted cough peak flow was found in air stacking via a ventilator compared with via a resuscitator bag. Both methods achieved mean air stacking-assisted cough peak flow values of >160 L/min. Provision of an inexpensive resuscitator bag can effectively improve cough capacity, and it is simple to use, which may improve access to respiratory care in people with DMD.
authors.affiliation: Ziekenhuis Inkendaal, Vlezenbeek, Belgium. michel.toussaint@inkendaal.be.
authors.forename: Michel
authors.initials: M
authors.lastname: Toussaint
authors.affiliation: Ziekenhuis Inkendaal, Vlezenbeek, Belgium.
authors.forename: Kurt
authors.initials: K
authors.lastname: Pernet
authors.affiliation: Ziekenhuis Inkendaal, Vlezenbeek, Belgium.
authors.forename: Marc
authors.initials: M
authors.lastname: Steens
authors.affiliation: Ziekenhuis Inkendaal, Vlezenbeek, Belgium.
authors.forename: Jurn
authors.initials: J
authors.lastname: Haan
authors.affiliation: Victorian Respiratory Support Service and Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia.
authors.forename: Nicole
authors.initials: N
authors.lastname: Sheers
mesh_terms: D000328:Adult; D003371:Cough / Q000503:physiopathology*; D006801:Humans; D001239:Inhalation; D020388:Muscular Dystrophy, Duchenne / Q000503:physiopathology* / Q000628:therapy*; D010366:Peak Expiratory Flow Rate; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000295:instrumentation*; D015656:Respiratory Mechanics / Q000502:physiology; D012122:Ventilators, Mechanical; D014797:Vital Capacity; D055815:Young Adult
keywords: Duchenne muscular dystrophy; air stacking; airway clearance; chest physiotherapy; cough