Respironics Cough Assist

CoughAssist is a noninvasive therapy that safely and consistently removes secretions in patients with an ineffective ability to cough (peak cough flow <270 l/m).

Typical Cough Assist patients include those with the following conditions:

• Amyotrophic lateral sclerosis
• Spinal muscular atrophy
• Muscular dystrophy
• Myasthenia gravis
• Spinal cord injuries

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CoughAssist clears secretions by gradually applying a positive pressure to the airway, then rapidly shifting to negative pressure. The rapid shift in pressure produces a high expiratory flow, simulating a natural cough.

• Removes secretions from the lungs
• Reduces the occurrence of respiratory infections
• Safe, noninvasive alternative to suctioning
• Easy for patients and caregivers to operate

• Can be used with a face mask, mouthpiece or with an adapter to a patient's endotracheal or tracheostomy tube
• Approved for home use in adults and children
• Available in automatic and manual models

CoughAssist is the only therapy that expels tracheobronchial secretions¹

• Respiratory tract infections are the most common cause of hospital admission in patients with neuromuscular disease⁴
• More than 90% of acute respiratory failure episodes in neuromuscular disorder (NMD) patients are caused by ineffective coughing during chest colds⁵

• CoughAssist has been clinically proven to:
  • Increase peak cough expiratory flows by more than fourfold⁶
  • Reduce recurrent respiratory infections in patients with respiratory weakness from neuromuscular disease^2,4,7,8

• CoughAssist can lead to improvement in perceived quality of life due to fewer acute illness-related episodes⁷
• Patients report that it feels "easier to breathe" after the use of CoughAssist⁷
• Wide range of available accessories ensure comfort for better compliance

1. Finder J. Overview of airway clearance technologies. July 2006. Available at: http://www.rtmagazine.com/issues/articles/2006-07_06.asp. Accessed August 12, 2007.
2. Bach JR. Mechanical insufflation/exsufflation: has it come of age? A commentary. Eur Respir J. 2003;21:385-386.
3. Finder JD, Birnkrant D, Farber CJ, et al. Respiratory care of the patient with Duchenne muscular dystrophy: ATS consensus statement. Am J Respir Crit Care Med. 2004;170:456-465.
4. Chatwin M, Ross E, Hart N, Nickol AH, Polkey MI, Simonds AK. Cough augmentation with mechanical insufflation/exsufflation in patients with neuromuscular weakness. Eur Respir J. 2003;21:502-508.
5. Tzeng AC, Bach JR. Prevention of pulmonary morbidity for patients with neuromuscular disease. Chest. 2000:118;1390-1396.
6. McCool DF, Rosen MJ. Nonpharmocologic airway clearance therapies: AACP evidence-based clinical practice guidelines. Chest. 2006; 129:250-259.
7. Miske LJ, Hickey EM, Kolb SM, Weiner DJ, Panitch HB. Use of the mechanical in-exsufflator in pediatric patients with neuromuscular disease and impaired cough. Chest. 2004;125:1406-1412.
8. Winck JC, Goncalves MR, Lourenco C, Viana P, Almeida J, Bach JR. Effects of mechanical insufflation-exsufflation on respiratory parameters for patients with chronic airway secretion encumbrance. Chest. 2004;126:774-780.
9. Data on file, Respironics, Inc.

Please refer to the CoughAssist Product User Manual for complete product description, including indications and contraindications for use. Once it has been determined that CoughAssist treatment is clinically appropriate, the following can be used as a suggested protocol.

• Reduced Peak Cough Flow (pcf) < 270 lpm necessary to clear bronchial secretions during an infection
  • PCF can be measured by pneumotach or by simple peak flow meter adapted to a facemask.
• A maximum expiratory pressure < 60 cm H₂0

• Any patient with a history of bullous emphysema
• Susceptibility to pneumothorax or pnuemo-mediastinum
• Recent barotrauma, should be carefully considered before use

The above contraindications should be carefully considered before use.

Attach CoughAssist user circuit to the CoughAssist output including a bacterial/viral filter, smoothbore tubing and an appropriate interface: mask, mouthpiece or trach adapter. If a mask is used, it should be of appropriate size to provide for a tight seal.

Begin with inspiratory pressures between +10 and +15 cm H₂0 and expiratory pressures of between -10 and -15 cm H20 to allow an introduction / acclimation period to the device.

Verify initial pressures or any changes in pressure requirements by occluding the circuit in a clean manner and cycling from inhale to exhale.

• This should be done several times while viewing the pressure gauge

• For Manual Mode: slide the manual toggle from inhale to exhale 4-6 times holding the inhale pressure for 2-3 sec, enough time to deliver a full deep breath, then rapidly to exhale for 2-3 sec
• For Auto Mode: slide to the Auto mode. Set the inhale time to 2-3 sec. and the exhale time to 2-3 sec

Slowly adjust the pressures upward with subsequent treatments by 5 cm H₂0 each cycle on 4-6 breaths until optimal pressures are reached to clear secretions.

• Typical inhale pressures may vary between 15 cm H₂0 to 40 cm H₂0.
  • Optimal inhale pressure may vary from patient to patient depending on lung and chest wall compliance.
• Optimal exhale pressure may vary between 35cm H₂0 and 45 cm H₂0.

• A standard treatment consists of applying 4-6 consecutive cycles of insufflation/exsufflation.
• Visible secretions should be removed via suction from mouth, tracheostomy tube or tubing.
• The user should then rest for 20-60 seconds and return to their normal mode of ventilation and prescribed oxygen flow if needed.

• CoughAssist treatment can be applied through a tracheostomy tube by using a 15 mm trach adaptor or by adapting to inline suction catheter that would allow for easy removal of secretions from the trach tube.
• Higher exhale pressures may be required to overcome the increased resistance of a tracheostomy or endotracheal tube.
• When treating with the CoughAssist through a trach tube, it is advisable to use a means for trapping any secretions that may potentially accumulate in the treatment circuit.
  • Standard water traps, sputum traps, or extension tubing with corrugated inner walls can serve well for this purpose.

• CoughAssist has been assigned HCPCS Code E0482
• Covered by most private insurance providers
• Covered under a number of Medicaid plans