• Expiratory cough assist techniques improve the force of a cough by manually assisting your child’s abdominal or thoracic (chest) muscles while he exhales (breathes out) and coughs. This expiratory assistance helps your child clear his respiratory tract of secretions.
• Abdominal thrusts support and in some cases, completely replace the role of weak abdominal muscles that normally control forced exhalation.
• Thoracic (chest) and thoracic lateral compressions are used to help the chest muscles to better perform their work.
• Directed cough assist (or auto cough assist or independent cough assist or auto cough assistance) allows your child, if sufficiently independent, to apply this technique himself when he is alone and needs to clear his secretions. He must nonetheless have enough strength in his arms as well as good balance to apply this technique.
• These expiratory assist techniques can be used regularly to prevent or to treat pulmonary infections.
• Below is a suggested method that can serve as a guide; discuss any other specifications that may be required for your child with the healthcare team.

Considerations:

• These techniques are more effective when the lungs are filled with air. Based on your child’s condition and the results of tests (pulmonary function tests), your healthcare team may recommend the use of these techniques simultaneously with the inspiratory cough assist technique. In these circumstances, it may be easier to have 2 people to apply the technique.
• Good handwashing is essential before and after providing care.
• Ensure the comfort of your child during the care by using different positioning techniques and distraction techniques.

• 3 to 5 maneuvers per session (1 maneuver = 1 inspiration with bag/1 expiration/1 abdominal thrust, 1 lateral thoracic (chest) compression or 1 thoracic compression), if applicable.
• If the secretions are not sufficiently cleared: 5 to 8 maneuvers or until your child clears the secretions with an effective cough.
• 2 to 4 sessions per day regularly or more if needed, according to your child’s healthcare team.
• It is suggested that each session not last more than 10 minutes in order to avoid hyperventilation and dizziness.
• It is suggested that you wait 10 minutes between each session.
• In order to avoid stomach discomfort and food reflux or vomiting apply the technique before meals or at least 2 hours after a meal.