As you are no doubt aware, it is very important that airway secretions
be coughed up, since there is an increased risk of pneumonia in a
patient who cannot cough to rid the lungs of secretions.
You may want to consider purchasing a device to assist your wife in
coughing. Below you will find information on two devices that can be
used in the home, and that are non-invasive. The first of these, the
CoughAssist, is a device with which I am personally familiar. My
brother suffered from a degenerative neurological condition that
rendered him unable to cough. The CoughAssist machine was immeasurably
useful in helping to keep his lungs clear.
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The CoughAssist Mechanical Insufflation-Exsufflation device:
"The In-Exsufflator Cough Machine is a device for helping clear
secretions in people who have difficulty with coughing. It has been
used for people with post-polio, muscular dystrophy, SCI, and ALS...
The machine operates with a blower and a valve that applies a positive
pressure first to give a deep breath in, and then shifts rapidly to
negative pressure to create a high expiratory flow, like one has with
a normal cough. It can be used on a person with a trach or someone
without a trach through a face mask or mouthpiece. The circuit is a
bacterial filter, a pressure tap, and a hose to the face mask or
adapter to the trach tube. There are two models: one with automatic
timing and one manual. Typically, a session of coughing with the
machine involves cycling the unit positive, then negative, in quick
succession about five to six times. Then the patient is allowed to
rest for a minute in order to prevent hyperventilation which can occur
after more than five to six times in a row. This pattern is repeated
four to five times. When secretions arise, they come out into the mask
or are spit out... A cough session takes about 10-15 minutes for
secretion removal... Many patients do not need to use the
In-Exsufflator continuously, just for respiratory tract infections.
Many have avoided pneumonias that required hospitalization and
intubations by using the device."
ALS Association of Oregon
http://www.alsa-or.org/treatment/InExsufflator.htm
"This latest version of the In-Exsufflator Cough Machine (aka
Cofflator) is easy to use and features a sleek new design, quieter
operation, an adjustable internal inhale-flow restrictor, a simpler
breathing circuit and an optional mobile stand.
Like its predecessor, the non-invasive CoughAssist safely and
effectively clears retained broncho-pulmonary secretions, reducing the
risk of respiratory complications. The CoughAssist achieves this by
gradually applying a positive pressure to the airway, and then rapidly
shifts to negative pressure. The rapid shift in pressure produces a
high expiratory flow from the lungs, simulating a cough.
This technique, referred to as 'mechanical insufflation-exsufflation,'
avoids airway damage while offering patients greater comfort and
quality of life without the use of an invasive procedure. It has been
proven effective for patients with an insufficient ability to cough
due to poliomyelitis, muscular dystrophy, ALS, myasthenia gravis, or
other neurological disorder with some paralysis of the respiratory
muscle, such as spinal cord injury. This device may also treat
ineffective cough due to emphysema, cystic fibrosis, and
bronchiectasis."
J.H. Emerson Co.
http://www.jhemerson.com/products/products_cough.htm
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The Vest Airway Clearance System:
The Vest system is an easy-to-use airway clearance device for both
children and adults. It was introduced and cleared to market by the
U.S. Food and Drug Administration (FDA) in 1988. The device consists
of an inflatable vest connected by two tubes to a small air-pulse
generator. The current patented version is quiet and easy to
transport, enabling people to receive effective airway clearance
therapy at home, work, or on the road... The air-pulse generator
rapidly inflates and deflates the vest, gently compressing and
releasing the chest wall up to 25 times per second. This process,
called high-frequency chest wall oscillation (HFCWO), creates
mini-coughs that dislodge mucus from the bronchial walls, increase
mobilization, and move it along toward central airways. The action
also works to thin thick secretions, making them easier to clear. Once
the mucus has moved from the smaller to larger airways, it can be
easily removed by coughing or suctioning... Most users manage therapy
without any help. Unlike manual chest percussion therapy (CPT), The
Vest system treatment does not require special positioning or
breathing techniques. The technology is technique-independent because
user or caregiver factors do not compromise its effectiveness. A
typical treatment takes 15-20 minutes.
Advanced Respiratory
http://www.abivest.com/products/vest.asp?gs=patients
The Vest Airway Clearance System can help clear airway secretions in
patients with many kinds of medical conditions; included on the list
is Cerebral Vascular Accident (CVA), or stroke.
Advanced Respiratory
http://www.abivest.com/conditions/pdrl.asp?gs=patients
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In addition to devices such as the ones described above, there are
manually-assisted coughing techniques involving abdominal thrusts and
chest physiotherapy methods. These involve the active assistance of
the patient, however, and might not be effective if your wife has
reduced comprehension of what is required of her. If you think your
wife would be able to participate in a manually-assisted procedure, I
can provide more information on learning these techniques.
Search terms used:
assisted cough
induced cough
artificial cough
airway secretions
insufflation
exsufflation
forced expiratory technique
chest physiotherapy
Although Google Answers is not a source of authoritative medical
advice, I hope the information above will help you to discuss the
options for your wife's care with her physicians. If anything is in
need of explanation, or if a link does not function, please request
clarification before rating my answer; I'll be glad to offer further
assistance, as needed.
Best wishes,
pinkfreud |
