FAQ – Cough assist care

When to consult your healthcare team

General state of health

When your child has any of the following symptoms:

Fever (≥ 38⁰C rectal or ≥ 5⁰C oral or ≥ 37.5⁰C armpit).
General irritability, poor appetite, fatigue or wanting to sleep more than usual (lethargy).
Signs and/or symptoms of breathing difficulties:
- Short of breath, trouble breathing or noisy breathing,
- Breathes more quickly,
- Chest pain,
- Coughs more than usual or weaker cough,
- Heart rate faster than usual,
- Chest retraction and/or nasal flaring,
- Oxygen saturation monitor indicates that your child has a decreased oxygen saturation compared to their normal values,
- Purple or gray lips, tongue or fingertips (cyanosis),
- Clammy skin\cold extremities,
- Changes to behavior either fatigue or irritability,
- More comfortable breathing when sitting up,
- Extends their neck and head backwards to take in a breath.
Signs and/or symptoms of dehydration:
- Decreased urination
- Increased thirst
- Dry lips and mouth
- Faster heart rate than usual
- Weight loss
Your child experiences severe dizziness that lasts after 2 consecutive sessions of cough assist.
Your child’s abdomen remains bloated and/or your child burps after lung volume recruitment technique or insufflation/exsufflation technique.

Respiration/respiratory muscles

Your child experiences chest/abdominal pain during lung volume recruitment technique or manual thrusts.
You are unable to clear your child’s secretions.
Your child’s abdomen does not move outwards during lung volume recruitment technique or insufflation/exsufflation technique.

Equipment

A leak around the mouthpiece or through the nose that persists during lung volume recruitment technique or insufflation/exsufflation technique.

Health

Your child experiences severe dizziness that lasts after 2 consecutive sessions of cough assist.
Your child’s abdomen remains bloated and/or your child burps after lung volume recruitment technique or insufflation/exsufflation technique

Your child’s healthcare team will take the opportunity during your child’s follow-up appointments to review your child’s care and equipment. Adjustments will be made as required.

PLEASE NOTE: The information in this section is meant as a general guide to help parents and caregivers with common issues and is not intended to replace the care provided by your child’s healthcare team.

Discuss your child’s unique needs with the healthcare team, including WHO and WHEN to contact when problems arise.

Fever with or without general malaise: (≥ 38⁰C rectal or ≥ 37.5⁰C oral/armpit)

Possible cause(s)

Respiratory infection
Other infection

What to do?

Contact your healthcare team quickly.

General irritability, poor appetite, fatigue or wanting to sleep more than usual (lethargy)

Possible cause(s)

Change in baseline health of the child may indicate new infection or other problem

What to do?

Note any other changes or symptoms that your child may have.
Contact your healthcare team quickly.

One or more of these symptoms of breathing difficulties: shortness of breath, trouble breathing or noisy breathing; breathing more quickly; chest pain; coughing more than usual or has a weaker cough; faster heart rate than usual; chest retractions and/or nasal flaring; decreased oxygen saturation compared to their normal values; purple or gray lips, tongue or fingertips (cyanosis); clammy skin\cold extremities; changes to behavior either fatigue or irritability; more comfortable breathing when sitting up; extends their neck and head backwards to take in a breath

Possible cause(s)

Equipment malfunction
Respiratory tract infection (eg, tracheitis, pneumonia
Mucous plug
Other health problems

What to do?

If your child is in SEVERE respiratory distress:
- Call 911 immediately.
- If required, begin manual ventilation and CPR as instructed.
If your child is in MILD respiratory distress:
- Try suctioning the secretions.
- If your child has medications that have been previously prescribed for these symptoms (eg, Ventolin), administer them as prescribed or according to your child’s healthcare team.
- Contact your child’s healthcare team immediately.

One or more of these symptoms: decreased urination, increased thirst, dry lips and mouth, faster heart rate than usual, weight loss

Possible cause(s)

Dehydration

What to do?

Contact your healthcare team quickly.
Give oral rehydration solutions to your child (eg Pedialyte™, Gastrolyte™), if recommended by your healthcare team.

Dizziness or fatigue

Possible cause(s)

Less than 10 minutes between each session
Session is too long

What to do?

Let your child rest.
Wait 10 minutes between each session.

If the dizziness is severe:

Stop the technique immediately.
If the symptoms reappear again, contact the healthcare team.

Bloating of the abdomen with burping after lung volume recruitment technique or insufflation/exsufflation technique

Possible cause(s)

Air is entering the stomach instead of the lungs

What to do?

Remind your child to relax during the insufflations of air; he must not resist air entry.

If the discomfort persists:

Stop the technique immediately.
Quickly contact the healthcare team.

Stomach upset during lung volume recruitment technique or insufflation/exsufflation technique

Possible cause(s)

The technique was applied during or immediately following a meal

What to do?

Stop the technique immediately unless your child is really congested with secretions.
Avoid applying the technique within 2 hours before or after a meal.
If needed, suction the secretions.

Chest/abdominal discomfort or pain during lung volume recruitment (breath stacking) or insufflation/exsufflation technique

Possible cause(s)

Sore chest or abdominal muscles
Too much air in the lungs

What to do?

It is normal that your child feels a slight pulling of the chest muscles when the therapy is first started. This discomfort will gradually disappear.

If he feels pain:

Stop the technique immediately.
Contact the healthcare team as soon as possible.

Inability to expectorate (clear) the secretions

Possible cause(s)

Poor technique
Thicker secretions
More secretions than usual

What to do?

Review the technique.
Combine more than one technique at a time (eg, pulmonary hyperinflation with abdominal thrusts) in order to increase the efficacy of secretion clearance.
Make sure that the humidity level is adequate.
If the problem persists, contact the healthcare team quickly.

Abdomen does not move outwardly during lung volume recruitment technique or insufflation/exsufflation technique

Possible cause(s)

Poor technique
Lack of collaboration by your child

What to do?

Review the technique.
Make sure that there is no leak (mouthpiece, facial mask, tubing).
Make sure that your child is relaxed.
If the problem persists, contact the healthcare team.

Abdomen does not move outwardly during lung volume recruitment technique or insufflation/exsufflation technique

Possible cause(s)

Poor seal around the mouthpiece

What to do?

Make sure that your child closes his mouth firmly around the mouthpiece.
Make sure that the mouthpiece is properly inserted in the modified ventilatory bag.
If needed, use a facial mask.
If the problem persists, contact the healthcare team.

Leak from the nose during lung volume recruitment technique or insufflation/exsufflation technique

Possible cause(s)

The air is leaking through the nose rather than going to the lungs

What to do?

Use a nose clip.
If the problem persists, use a facial mask.
If the problem continues to persist, contact the healthcare team.

Do not hesitate to refer to your child’s healthcare team for any questions or for specific advice related to your child’s condition.

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