Coughing up and mobilising secretion

Coughing up secretion is very important to enable you to breathe freely. Coughing is a protective reflex for cleaning the respiratory tract since it loosens the mucous which can then be transported out of the airways.

Coughing requires abdominal and rib muscles. For people with spinal cord injury, these muscles may be impaired depending on the diagnosis, the type of paralysis and the impairment level. It is therefore possible that they will need support when coughing up secretion.

How can coughing up be supported?

• Move into a good body position.
• Breathe in deeply and deliberately.
• Increase pressure by closing the vocal folds – the counter pressure that is created expands the bronchial tubes.
• Cough strongly and briefly but without cramping.
• Breathe deeply between coughs.

It is harder to cough up thick mucus. You should therefore drink enough, especially tea (anise, fennel, thyme, ribwort, mallow and licorice).

Inhalations can help to liquefy the mucus. Best suitable are inhalations using a saline solution. Sodium chloride is atomised into tiny drops by using an ultrasonic or injector nebuliser. They go deeply into the respiratory tract when inhaling whereas with standard inhalation procedures the bronchi cannot be reached. Saline solutions and nebulisers can be bought in pharmacies.

Manual assistance by a caregiver

A powerful coughing action is needed to cough up mucous or during swallowing. If the person lacks strength in their abdominal muscles, a caregiver may help them to cough up secretions.

Sudden pressure is exerted on the abdominals and lower chest area in connection with the coughing mechanism.

Mobilising secretion with Cough Assist

If the respiratory muscles are weakened or partially paralysed, the ability to cough efficiently and to expel possible secretion is diminished. The device Cough Assist offers efficient support to release (to mobilise) the secretion. By switching fast from positive pressure during the inhalation phase to negative pressure during the exhalation phase, natural coughing up is simulated.

In order to follow an efficient therapy without complications when using Cough Assist, patients and support staff must be instructed by qualified professionals.

What is needed for the therapy?

• Cough Assist equipped with a device filter, tube and mask / mouthpiece or catheter mount (if tracheal tube present)
• Towels to absorb coughed-up secretion
• Extractor system if needed
• Possibly NaCl 0.9 % 10 ml in Mini-Plasco ampoules to better liquefy and therefore mobilise thick secretion

Preparation of the therapy

• If possible, put the patient in an upright position.
• Position the arms in such a way that there is enough space to extend the chest.
• Check the device settings before each use – the settings should be made upon consultation with a doctor or qualified nursing staff.
• Put on the mask, mouthpiece or catheter mount.

Procedures

• One cycle:
  • put toggle switch on “inhale” for 2-4 sec.
  • switch immediately to “exhale” for 3-5 sec.
  • take a short break (1-2 sec.)
• Repeat cycle 3-6 times
• Depending on how much secretion is present, suctioning and/or cleaning of the mask, mouthpiece or Mount Catheter is necessary.
• If not all secretion was mobilised, further cycles can be performed after a recovery phase (several minutes, depending on how the person feels).
• If the person using Cough Assist does not need any assistance and is able to install the mouthpiece / mask by him / herself, he or she can choose auto mode. The individually set device then performs the pressure change automatically, from inhale to exhale followed by a break.

The tubes need to be exchanged once per week. If dirty in between, they should be cleaned under flowing water and allowed to dry.