SYSTEMATIC REVIEW OF TECHNIQUES TO ENHANCE PEAK COUGH FLOW AND MAINTAIN VITAL CAPACITY IN NEUROMUSCULAR DISEASE: THE CASE FOR MECHANICAL INSUFFLATION-EXSUFFLATION

Patients with neuromuscular disease risk developing chest infections due to the inability to cough effectively and to maintain adequate lung volume. This systematic review aimed to evaluate the comparative effectiveness of techniques used in the respiratory management of these patients. Articles evaluating peak cough flow measurements and maintenance of lung volumes only were selected to retain a specific focus for comparison. A database search was performed using the Cochrane controlled register, AMED, Cinahl, Medline and PEDro. Various techniques improved cough efficacy in neuromuscular disease by increasing peak cough flow values and maintaining lung volume. Mechanical insufflation-exsufflation is a technique used to augment cough strength, producing the greatest increase in peak cough flow compared with other techniques. These findings highlight the treatment options for the patient with neuromuscular disease in order to maintain respiratory muscle length, prevent infection and augment peak cough flow.