Breathing and sleep
Weak cough and clearing secretions
A cough that no longer has enough force to clear the airway, so mucus and secretions are harder to shift.
Still being checked
What this is
Coughing needs three things: enough air in, enough force out, and the throat closing and opening at the right moment. ALS/MND can weaken all three. This matters most during a chest infection, when clearing the airway is exactly what you need to be able to do, which is why the techniques and devices are usually set up before they are urgently needed.
What people often describe
- Coughing that feels weak, or that does not shift anything
- Needing several goes to clear your throat
- Feeling that something is sitting there that you cannot move
- A cold going to the chest and staying longer than it used to
Important distinctions
A weak cough is about the force available to move secretions. Thick secretions are about what the secretions are like. Many people have both, and each is managed differently.
Breathlessness is about the effort of breathing. A weak cough is about clearing the airway. They come from the same muscles and are assessed together.
What may help
This page lists options that are used for this problem and says where each one comes from. It is not a ranking, it is not a recommendation, and it is not personalised to you. What suits you is a decision for you and your care team.
Practical and self-management
Things people do themselves, or with whoever is helping them.
Allied health
What a therapist can assess, teach or adjust.
Medicines
Named here only where a guideline names them for this problem.
Equipment
Devices and physical aids.
When to get this looked at sooner
A chest infection that is not improving, or feeling unusually unwell with your breathing, is worth raising promptly rather than waiting for the next review. A chest infection in particular is worth seeing a doctor about as soon as possible, and that matters more when your cough is not clearing your chest on its own.
Who may help
Where Compass explains this
Questions
- Why can coughing and clearing mucus become harder in ALS/MND?
- What other ways can help clear the airway and secretions?
- When might cough support be introduced?
- What should I ask my team about cough and secretion support?
Cards
Related
Other problems
Words explained
About this page
This page lists options that are used for this problem and says where each one comes from. It is not a ranking, it is not a recommendation, and it is not personalised to you. What suits you is a decision for you and your care team.
Evidence for this page
The sources behind the statements on this page, and where to find them. Compass does not decide which option is right for anyone.
Statement 1 of 5. Getting more air in behind a cough, or having someone add force to it. NICE names these as the first thing to try for an ineffective cough.
Supports this. NICE MND guideline — NICE · Clinical guideline
NICE says to offer cough augmentation techniques such as manual assisted cough to people who cannot cough effectively.
“Offer cough augmentation techniques such as manual assisted cough to people with MND who cannot cough effectively.”
1.14.1Link checked August 2026
Supports this. NICE MND guideline — NICE · Clinical guideline
NICE names unassisted breath stacking and manual assisted cough as the first-line treatment, before a device is considered.
“Consider unassisted breath stacking and/or manual assisted cough as the first-line treatment for people with MND who have an ineffective cough.”
1.14.2Link checked August 2026
Statement 2 of 5. A chest infection is both the time you most need to clear your airway and one of the reversible causes NICE tells teams to treat first.
Supports this. NICE MND guideline — NICE · Clinical guideline
NICE tells teams to treat reversible causes, naming respiratory tract infections and secretion problems, before considering other treatments.
“Treat people with MND and worsening respiratory impairment for reversible causes (for example, respiratory tract infections or secretion problems) before considering other treatments.”
1.13.1Link checked August 2026
Statement 3 of 5. A machine that pushes air in and pulls it out again. NICE positions it for when the simpler techniques are not enough, and during a chest infection.
Supports this. NICE MND guideline — NICE · Clinical guideline
NICE says to consider a mechanical cough assist device where assisted breath stacking is not effective, and during a respiratory tract infection.
“Consider a mechanical cough assist device if assisted breath stacking is not effective, and/or during a respiratory tract infection.”
1.14.4Link checked August 2026
Qualifies this. Cough augmentation techniques for people with chronic neuromuscular disorders — Cochrane · Research review · 2021
A Cochrane review of cough augmentation in neuromuscular disease reports that the included studies did not measure hospital admissions, and that there was not enough evidence to determine effects on several other outcomes. It is a statement about what the research has measured, not about whether the technique helps.
“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 resultsLink checked August 2026
Statement 4 of 5. Clears what has reached the mouth and upper airway. It does not reach the chest, so it works alongside the clearance techniques rather than instead of them.
Supports this. Guidelines for the physiotherapy management of MND — Irish Motor Neurone Disease Association · Clinical guideline · 2014
An MND physiotherapy guideline describes oral suctioning as useful where upper airway secretions are difficult to clear.
“Oral suctioning using a yanker is useful in patients with upper airway secretions which are difficult to clear.”
Section 3.4c.1 Recommendations, item ZLink checked August 2026
Statement 5 of 5. A chest infection that is not improving, or feeling unusually unwell with your breathing, is worth raising promptly rather than waiting for the next review. A chest infection in particular is worth seeing a doctor about as soon as possible, and that matters more when your cough is not clearing your chest on its own.
Supports this. NICE MND guideline — NICE · Clinical guideline
Republished from the Compass answer "What breathing symptoms should I tell my team about between appointments?", where this statement is already mapped to this source.
“Treat people with MND and worsening respiratory impairment for reversible causes (for example, respiratory tract infections or secretion problems) before considering other treatments.”
1.13.1Link checked August 2026