Scary Moments... Cough Assist Machine to the rescue! by Andrea Duckworth

I have been asked to share a recent experience with you. In December, the week leading up to Christmas, I was unwell with a virus. My sinuses seemed permanently blocked and I was constantly blowing my nose.

I felt at times I couldn’t breathe properly due to the congestion. I took the usual remedies; paracetamol, Nurofen, Vicks and also a decongestant.

In addition I increased the use of my cough assist machine, sometimes using it 10 times a day to try and clear the congestion. On the Sunday before Christmas I had a very scary moment. Despite using the cough assist machine, I couldn’t clear the catarrh from my throat. It felt trapped and was affecting my ability to breathe. I could feel myself becoming anxious and very hot. I took off some of my clothes, opened the window for some air and then went back on my cough assist. My husband and daughter came to try and help but they felt helpless and my husband asked if I he needed to ring the hospital. I said that if I couldn’t clear it then yes. I kept persevering with the cough assist machine and thankfully I managed a good cough and the catarrh did eventually clear. I was very frightened though and it made me feel particularly vulnerable.

The next day I made a doctors’ appointment and also rang the NMC Physio Team for advice and reassurance. Due to my vulnerability, I was put on a course of antibiotics. Whilst they did not shorten the length of time that I had the virus, they did stop it from getting any worse and turning into something nasty such as pneumonia.

I consider myself to be healthy, very rarely ill and things never generally phase me. However, on this occasion I was scared. I am so grateful that I have a cough assist machine at home. Through using it on a daily and regular basis I was not phased by using it more frequently in an acute situation. Had I not had a machine at home, I would have been admitted to hospital.

I would say to anyone who has respiratory problems that a cough assist machine really can help your respiratory well being. If you think you could benefit from using a Cough Assist Machine, please speak to your Consultant and / or seek advice from The Physio Team at NMC.

Past editions of One Voice are a treasure-trove of useful information. They are available on the NMC website, but in addition, we have set up a website onevoicearticles.blogspot.co.uk. We will post articles on this site that appear in One Voice, and we will try to add as many past articles as we can. We hope that it will make it easier to search for and find topics that have been covered in previous editions.

Cough Assist Machine, A Patient’s Perspective – Andrea Duckworth

It was whilst at a routine home appointment to replace my ventilator (which I use at night), that the nurse explained that she felt my breathing seemed slightly laboured and I seemed a bit hoarse.

She suggested a few things, one of which was a Cough Assist machine. A few weeks later she came back to visit, armed with the Cough Assist Machine and the Respiratory Physiotherapist.

They both explained how the machine worked and took me through it step by step. Firstly they had a go just to illustrate how it worked. Then it was my turn! It took a bit of getting used to but they adjusted the settings until I felt comfortable with them. The pressure is quite forceful but the key is to get into a good rhythm.

It took me a little while to feel really comfortable using it. The idea is that I use the Cough Assist machine prophylactically (as a preventative measure) to keep everything clear and flowing smoothly, rather than waiting to get a bad cough or cold and then really needing to use it, but actually feeling to tired and weak to use it. It is quite a forced pressure but one that you can get used to.

I try and use the Cough Assist morning and night so that once I get out of bed in the morning I am able to clear any secretions that have developed overnight, and again before I get into bed in the evening so that I clear any secretions before I lie down at night.

It is another gadget to store but it’s just under my bed and I just pull it out to use it. I have really found that this has helped me – it makes my throat feel clearer, my breathing seems better and I feel more alert. I feel I am doing as much as I can to help my breathing be as effective as possible within the disease limitations. I hope that I do not pick up coughs and colds but I am reassured that my Cough Assist machine will help that bit more if I do get one!

Cough Assist Machine – A Clinical Perspective Jonny Smith

Cough assist (or Mechanical Insufflation-Exsufflation) is a chest clearance device which uses negative air pressure to simulate a functional human cough. The machine works by delivering a preset 'breath in', or inhalation, which fully inflates the lungs and moves air behind secretions. It then rapidly switches to a preset 'breath out', or exhalation, which draws secretions mouthwards to be cleared from the chest. This is typically performed through a mouthpiece or mask and the newer machines have various settings to tailor the treatment to the individuals.

Chest infections can be extremely dangerous, particularly if you are unable to clear your chest effectively. Regular use of a Cough assist prevents accumulations of secretions within the chest, which in turn removes favourable conditions for bacteria to multiply and helps to prevent chest infections. In addition, in the event of a chest infection, the cough assist removes infected secretions to clear the airways and improves breathing - just like a functional human cough!

Individuals may require a cough assist when they have weak respiratory muscles - those such as the diaphragm, muscles of the ribs and abdominals - and can no longer effectively clear their chests independently. The guidance for individual need of a cough assist is contained within the British Thoracic Society guidance on Neuromuscular Conditions, which was published in 2012. Cough assist machines are becoming much more widely used because of the advantages they confer over other chest clearance options (such as suction or manual-assisted coughing) with relatively few drawbacks. The most effective method of using a cough assist device is to use it every day, even when you are feeling well, to fully inflate the lungs, keep secretions moving and prevent issues such as chest infections from ever occurring.

If you feel your cough is weak, or has weakened recently, to the point where you are unable to effectively clear your chest, you should alert your physiotherapist or specialist clinician as you may be in need of respiratory support. Even if you feel capable of clearing your chest when you are not unwell, the effects of infection and repeated coughing can leave you fatigued and adversely affect your cough strength. As always, prevention is better than cure! And it is better to have &
rarely need, than rarely need & not have!