08O To manually or mechanically cough: that is the question! Cough augmentation in children with neuromuscular disorders: a feasibility study

• Published in: Neuromuscular disorders : NMD Vol. 43; p. 104441
• Main Authors: Human, A., Corten, L., Morrow, B.
• Format: Journal Article
• Language: English
• Published: Elsevier B.V 01.10.2024
• ISSN: 0960-8966
• DOI: 10.1016/j.nmd.2024.07.403

An ineffective cough contributes to morbidity and mortality in children with neuromuscular disorders (NMD). Mechanical cough augmentation is recommended in clinical practice guidelines and used in standardised care, but has not been assessed in South Africa (SA). This feasibility study investigated the effect of cough augmentation among children with NMD (5-18 years) hospitalised for respiratory infections, secretion retention and weak cough. Patients were randomly allocated to either manually assisted cough (MAC, n=6) or mechanical insufflation exsufflation (MI-E, n=5). Both groups were similar at baseline. All 11 participants (median (IQR): 5.58 (4.33 – 14.33) years) attended the same Paediatric hospital in the Western Cape, SA. The majority were female (n=8), non-ambulant (n=10) and presented with spinal muscular atrophy (n=6). No differences in ventilatory support duration, vital signs, and patient satisfaction with cough technique were found between groups. There was however a significantly lower NMD severity score (/13) at discharge [mean difference (95% CI): -2.300 (-4.359 – (-0.241))], favouring the MAC participants and a trend towards shorter hospitalisation for the MI-E group [mean difference (95% CI): 2.150 (-0.198 – 4.498) days]. The use of MAC showed no adverse events and only one participant experienced nausea and vomiting during MI-E. Although feedback from parents/caregivers in the MI-E group (4/5) preferred MI-E above MAC due to comfort and perceived efficacy, neither technique seems superior in the treatment of children with NMD. Therefore, both cough augmentation strategies seem to be safe in this patient cohort, however, larger, experimental studies are required to inform clinical practice in SA.