Cough augmentation techniques for people with chronic neuromuscular disorders

Cough Assist Devices

• What does using cough assist feel like, and how is it used day to day?

  iAdds context

  “Many people who use a cough assist device report that it makes clearing the chest much easier.”

  Worth holding alongside that. What people report and what trials have measured are different things, and the trials this review found did not measure how people felt about cough support at all.

  There was insufficient evidence to determine the effect of interventions on measures of gaseous exchange, pulmonary function, quality of life, general function, or participant preference and satisfaction.

  Main results

• What is a cough assist device and how does it help?

  !Qualifies this

  “The UK guideline recommends considering a cough assist device during a chest infection. Randomised trials up to 2020 had not measured whether it changes how infections turn out, though other studies report fewer hospital admissions and longer survival for cough support with non-invasive ventilation.”

  A review of 11 randomised trials, 287 adults and children with chronic neuromuscular disorders rather than ALS/MND specifically, with its evidence current to April 2020. Hospital admissions for chest infections were the review's own primary outcome and not one trial reported them, so this is a question that has not been studied, rather than one that was studied and came back showing no benefit.

  None of the included studies reported on the primary outcomes of this review (number and duration of unscheduled hospital admissions)

  Main results

• Why can coughing and clearing mucus become harder in ALS/MND?

  iAdds context

  “A cough too weak to clear the airway makes chest infections more likely.”

  Background to a Cochrane review of cough support. It describes the same chain for neuromuscular conditions as a group rather than for ALS/MND specifically, so it is corroboration rather than the basis for this sentence.

  People with neuromuscular disorders (nerve-related conditions that affect the muscles) may have difficulty coughing and clearing mucous from the airways, placing them at risk of choking, recurrent chest infections, and ongoing lung disease.

  Background