Skip to main content
SpringerLink
Log in

Airway Clearance Techniques in Neuromuscular Disorders

  • Chapter
  • First Online:
Noninvasive Ventilation in Sleep Medicine and Pulmonary Critical Care

Abstract

Neuromuscular diseases (NMD) associated or not with cough impairment involve many morbidity and mortality in the early stages of life. In these patients, the composition and volume of secretions are generally normal. However, the effectiveness of cough is affected in the inspiratory and expiratory phases due to muscular weakness. To the physicians who treat NMD, it is essential to know airway clearance techniques to help prevent some secondary atelectasis and pneumonia and, therefore, to improve the quality of life in NMD patients. The following chapter will give an update on the airway clearance techniques available among neuromuscular disease patients. Therefore, a systematic literature search in the PubMed database was performed including clinical trials, meta-analysis and reviews published between January 2017 and March 2019.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 99.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Abbreviations

ACTs:

Airway clearance techniques

ALS:

Amyotrophic lateral sclerosis

AS:

Air stacking

CWS:

Chest wall strapping

FVC:

Forced vital capacity

GPB:

Glossopharyngeal breathing

HFCWC:

High-frequency chest wall compression

HFCWO:

High-frequency chest wall oscillations

IPPB:

Intermittent positive pressure breathing

IPV:

Intrapulmonary percussive ventilation

LIC:

Lung insufflation capacity

MAC:

Manually assisted cough

MEP:

Maximal expiratory pressure

MIC:

Maximum insufflation capacity

MI-E:

Mechanical insufflation-exsufflation

MIP:

Maximal inspiratory pressure

NMD:

Neuromuscular diseases

NIV:

Noninvasive ventilation

PCF:

Peak cough flow

PEP:

Positive expiratory pressure

RV:

Residual volume

SMA:

Spinal muscle atrophy

VC:

Vital capacity

References

  1. Rajendran RR, Banerjee A. Mucus transport and distribution by steady expiration in an idealized airway geometry. Med Eng Phys. 2019;66:26–39. https://doi.org/10.1016/j.medengphy.2019.02.006.

    Article  PubMed  Google Scholar 

  2. Bustamante-Marin XM, Ostrowski LE. Cilia and mucociliary clearance. Cold Spring Harb Perspect Biol. 2017;9(4):a028241. https://doi.org/10.1101/cshperspect.a028241.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Sahni AS, Wolfe L. Respiratory care in neuromuscular diseases. Respir Care. 2018;63(5):601–8. https://doi.org/10.4187/respcare.06210.

    Article  PubMed  Google Scholar 

  4. Rose L, McKim D, Leasa D, et al. Monitoring cough effectiveness and use of airway clearance strategies: a Canadian and UK survey. Respir Care. 2018;63(12):1506–13. https://doi.org/10.4187/respcare.06321.

    Article  PubMed  Google Scholar 

  5. Andersen TM, Sandnes A, Fondenes O, et al. Laryngeal responses to mechanically assisted cough in progressing amyotrophic lateral sclerosis. Respir Care. 2018;63(5):538–49. https://doi.org/10.4187/respcare.05924.

    Article  PubMed  Google Scholar 

  6. Bach JR. Noninvasive respiratory management of patients with neuromuscular disease. Ann Rehabil Med. 2017;41(4):519–38. https://doi.org/10.5535/arm.2017.41.4.519.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Sheers N, Howard ME, Berlowitz DJ. Respiratory adjuncts to NIV in neuromuscular disease. Respirology. 2019;24:512–20. https://doi.org/10.1111/resp.13431.

    Article  PubMed  Google Scholar 

  8. Chatwin M, Toussaint M, Gonçalves MR, et al. Airway clearance techniques in neuromuscular disorders: a state of the art review. Respir Med. 2018;136:98–110. https://doi.org/10.1016/j.rmed.2018.01.012.

    Article  PubMed  Google Scholar 

  9. Camela F, Gallucci M, Ricci G. Cough and airway clearance in Duchenne muscular dystrophy. Paediatric Respiratory Reviews. 2019;31:35–9. http://doi.org/10.1007/978-3-030-42998-0_9.

  10. Siriwat R, Deerojanawong J, Sritippayawan S, Hantragool S, Cheanprapai P. Mechanical insufflation-exsufflation versus conventional chest physiotherapy in children with cerebral palsy. Respir Care. 2017;63(2):187–93. https://doi.org/10.4187/respcare.05663.

    Article  PubMed  Google Scholar 

  11. Dwyer TJ, Daviskas E, Zainuldin R, et al. Effects of exercise and airway clearance (PEP) on mucus clearance in cystic fibrosis: a randomised cross-over trial. Eur Respir J. 2019;53:1801793. https://doi.org/10.1183/13993003.01793-2018.

    Article  CAS  PubMed  Google Scholar 

  12. Cabillic M, Gouilly P, Reychler G. Techniques manuelles de drainage bronchique des adultes et adolescents : quel niveau de preuve ? Rev Mal Respir. 2018;35(5):495–520. https://doi.org/10.1016/j.rmr.2015.12.004.

    Article  PubMed  Google Scholar 

  13. Gaynor M, Wood J. Mechanical insufflation-exsufflation for airway clearance in adults with cystic fibrosis. Respirol Case Rep. 2018;6(4):1–3. https://doi.org/10.1002/rcr2.307.

    Article  Google Scholar 

  14. Sarmento A, Resqueti VR, Dourado-Júnior MET, Aliverti A, Fregonezi G, de Andrade AD. Effects of air stacking maneuver on cough peak flow and chest wall compartmental volumes of amyotrophic lateral sclerosis subjects. Eur Respir J. 2017;50:PA2224. https://doi.org/10.1183/1393003.congress-2017.PA2224.

    Article  Google Scholar 

  15. Molgat-Seon Y, Hannan LM, Dominelli PB, et al. Lung volume recruitment acutely increases respiratory system compliance in individuals with severe respiratory muscle weakness. ERJ Open Res. 2017;3(1):00135–2016. https://doi.org/10.1183/23120541.00135-2016.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Auger C, Hernando V, Galmiche H. Use of mechanical insufflation-exsufflation devices for airway clearance in subjects with neuromuscular disease. Respir Care. 2017;62(2):236–45. https://doi.org/10.4187/respcare.04877.

    Article  PubMed  Google Scholar 

  17. Cesareo A, LoMauro A, Santi M, Biffi E, D’Angelo MG, Aliverti A. Acute effects of mechanical insufflation-exsufflation on the breathing pattern in stable subjects with Duchenne muscular dystrophy. Respir Care. 2018;63(8):955–65. https://doi.org/10.4187/respcare.05895.

    Article  PubMed  Google Scholar 

  18. Hov B, Andersen T, Hovland V, Toussaint M. The clinical use of mechanical insufflation-exsufflation in children with neuromuscular disorders in Europe. Paediatr Respir Rev. 2018;27:69–73. https://doi.org/10.1016/j.prrv.2017.08.003.

    Article  PubMed  Google Scholar 

  19. Esquinas AM, Fiorentino G. Considerations about the effect of cough assist on laryngeal function in neurologic disease. Respir Care. 2018;63(11):1459.1–1459. https://doi.org/10.4187/respcare.06547.

    Article  Google Scholar 

  20. Sahni AS, Wolfe L. Respiratory care in neuromuscular diseases. Respir Care. 2018;63(5):601. https://doi.org/10.4187/respcare.06210.

  21. Bidiwala A, Volpe L, Halaby C, Fazzari M, Valsamis C, Pirzada M. A comparison of high frequency chest wall oscillation and intrapulmonary percussive ventilation for airway clearance in pediatric patients with tracheostomy. Postgrad Med. 2017;129(2):276–82. https://doi.org/10.1080/00325481.2017.1264854.

    Article  PubMed  Google Scholar 

  22. Lee S-Y, Cho K-J. A study on the cough augmentation using a belt-driven assistive. In: 2017 International Conference on Rehabilitation Robotics (ICORR), vol. 2017. IEEE 2017. p. 1654–9. https://doi.org/10.1109/ICORR.2017.8009485.

  23. Kulnik ST. Could reflex cough induced through nebulized capsaicin achieve airway clearance in patients with acute retention of lung secretions? Med Hypotheses. 2018;119:104–9. https://doi.org/10.1016/j.mehy.2018.08.004.

    Article  CAS  PubMed  Google Scholar 

  24. Bertelli L, Di Nardo G, Cazzato S, Ricci G, Pession A. Free-Aspire: a new device for the management of airways clearance in patient with ineffective cough. Pediatr Rep. 2017;9(3):7270. https://doi.org/10.4081/pr.2017.7270.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Pulmonology Department, Unidade Local de Saúde da Guarda, Guarda, Portugal

    Marcos Oliveira & Rita Gomes

Authors
  1. Marcos Oliveira
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rita Gomes
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Intensive Care Unit, Hospital General Universitario Morales Meseguer, Murcia, Spain

    Antonio M. Esquinas

  2. Department of Pathophysiology and Pulmonary Rehab, Azienda Ospedaliera dei Colli PO Monaldi, Napoli, Italy

    Giuseppe Fiorentino

  3. Innovative Technologies for the Study of Sleep Breathing Disorders, Institute for Biomedical Research and Innovation (IRIB), Italian National Research Council, Palermo, Italy

    Giuseppe Insalaco

  4. Department of Pulmonary and CC Medicine, Lenox Hill Hospital, New York, NY, USA

    Bushra Mina

  5. Department of Respiratory and CC Medicine, First Affiliated Hospital of Chongqing M, Chongqing, China

    Jun Duan

  6. Anestesia and Pediatric Intensive Care Department, University Hospital Policlinico S. Orsola-Malpighi, Bologna, Italy

    Maria Cristina Mondardini

  7. Anestesia and Pediatric Intensive Care Department, University Hospital Policlinico S. Orsola-Malpighi, Bologna, Italy

    Fabio Caramelli

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Oliveira, M., Gomes, R. (2020). Airway Clearance Techniques in Neuromuscular Disorders. In: Esquinas, A.M., et al. Noninvasive Ventilation in Sleep Medicine and Pulmonary Critical Care. Springer, Cham. https://doi.org/10.1007/978-3-030-42998-0_9

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-42998-0_9

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-42997-3

  • Online ISBN: 978-3-030-42998-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation