What is it?
- Coughing is a natural process that the body uses to rid itself of irritating substances, such as secretions that are present in the respiratory tract.
- But in order for a cough to be effective, one must:
- be able to take a deep breath,
- be able to control the muscles that allow us to speak or make sounds,
- have sufficient force of the thoracic muscles (chest) and of the abdominal muscles (stomach).
- If one of these conditions is absent or modified because of illness or a health problem, coughing becomes ineffective causing an accumulation of secretions in the lungs.
- This accumulation of secretions can lead to respiratory infections and difficulty in breathing.
- Weakness or the ineffective functioning of the muscles that aid in breathing (larynx, thorax and the abdomen), or of the diaphragm (thin, dome shaped muscle that separates the chest from the abdomen) can also reduce the quality and the quantity of air that enters the lungs.
- The reduction of these volumes of air can cause a reduction of thoracic cage mobility that further compromises cough efficiency.
- To avoid these complications, your child must cough strongly enough to eliminate or prevent the accumulation of secretions in the lungs. Different cough assist techniques can be used to help your child cough effectively.
- Your child’s healthcare team will provide you with information regarding the cough assistance techniques most appropriate to your child’s condition and specific test results.
How does it work?
- Cough assist techniques help to strengthen and increase the effectiveness of your child’s cough when applied during one of the two phases of breathing: that is during inspiration (when air is taken into the lungs), expiration (when air leaves the lungs), or both. Cough assist techniques help clear secretions from the respiratory tract and also help your child spit out secretions (expectoration).
- One inspiratory aid technique is lung volume recruitment (also called breath stacking or manual hyperinflation therapy) using a modified ventilatory bag adapted with a one way valve and a series of connectors. Once adapted with a one way valve, this modified ventilatory bag, should never be used for resuscitation techniques.
- This technique helps your child take a big breath (inspiration) and increase the volume of air in the lungs. It also helps the diaphragm and thoracic muscles aid your child with a greater force during a cough.
- Lung volume recruitment is possible in children whether other methods of cough assistance are used or not.
- It is rarely used in children with tracheostomy.
- The technique requires the use of a facial mask or a mouthpiece.
- Manual expiratory aid techniques help your child cough during expiration. They are applied when the lungs are full of air. The external application of manual abdominal or thoracic compressions during expiration aid your child in coughing and clearing secretions. Manual expiratory assistant techniques include:
- abdominal thrusts or compressions
- thoracic or thoracic lateral compressions (chest or side of chest compressions)
- directed cough assist (or auto cough assist or independent cough assist or auto cough assistance).
- Mechanical inspiratory and expiratory aid techniques require the use of an insufflation / exsufflation (in-exsufflator) device (eg, Cough Assist®, E-70 or CA-3000).
These pressure generating devices quickly fill the lungs to the fullest capacity possible, and then quickly switch to a negative pressure to withdraw the air from the lungs on expiration.
This rapid movement of positive/negative pressure helps to mobilize pulmonary secretions towards the back of your child’s throat where they can be either expectorated (spit out) or if required, suctioned.
This cough assist technique can be used in children receiving ventilatory assistance or not.
It can be used on children with or without a tracheostomy.
The technique requires the use of a facial mask, a mouthpiece or a tracheal cannula adapter.
- Cough assist techniques can be used regularly to prevent complications but also to treat pulmonary infections.
- They do not cause pain but do require a certain adaptation period by your child. In younger children, consider the use of medical play to help your child adapt.
- The duration of each treatment session will vary from one child to another depending on the quantity of secretions, the effort required and the technique used.
- Based on your child’s condition and the results of tests, your child’s healthcare team can recommend the use of one or more cough assist techniques used simultaneously to help your child cough better.
Refer to your child’s healthcare team if other cough assist techniques (eg, inflating vest) are recommended for your child or if the medical devices used are different from the ones described in the methods of care here.
Your healthcare team will take the opportunity during your child’s follow-up appointments to answer any questions you may have or, if needed, make other recommendations.