Cough and airway clearance in Duchenne muscular dystrophy. (August 2019)

• Record Type: Journal Article
• Authors: Camela, F.; Gallucci, M.; Ricci, G.
• Is Part Of: Paediatric respiratory reviews. Volume 31(2019)
• Page Start: 35
• Page End: 39
• Publication Date: 2019-08
• Subjects: DMD Duchenne muscular dystrophy -- VC vital capacity -- PCF peak cough flow -- MIP maximal inspiratory pressure -- MEP maximal expiratory pressures -- FVC forced vital capacity -- PEF peak expiratory flow -- GBP glossopharyngeal breathing -- MIC maximum insufflation capacity -- IPV intrapulmonary percussive ventilation; Duchenne muscular dystrophy -- Cough -- Neuromuscular disease -- Peak cough flow -- Air stacking -- Mechanical insufflator–exsufflator; Pediatric respiratory diseases -- Periodicals; Respiratory organs -- Diseases -- Periodicals; Respiratory Tract Diseases -- Periodicals; Respiratory Therapy -- Periodicals; Child -- Periodicals; Appareil respiratoire -- Infections, chez l'enfant -- Périodiques; Appareil respiratoire -- Maladies, chez l'enfant -- Périodiques; 618.922
• DOI: 10.1016/j.prrv.2018.11.001
• Languages: English
• ISSNs: 1526-0542

Abstract

Abstract: People with Duchenne muscular dystrophy (DMD), develop a respiratory muscle weakness that results in weakened cough, airway clearance impairment and over time respiratory failure and death. Assessment of cough effectiveness through vital capacity, peak cough flow and maximal inspiratory and expiratory pressures has been used to identify the optimal timing of cough augmentation techniques initiation. The choice of therapies depends on physician knowledge, and patient/care giver abilities. The purpose of this review is to clarify mechanisms of action, benefits and disadvantages of available techniques, such as manual cough-assisting manoeuvres, glossopharyngeal breathing, air stacking by resuscitator bag or by volume-cycle ventilator, and mechanical insufflator–exsufflator. Mechanisms of mucus mobilization, like intrapulmonary percussive ventilation, may have a therapeutic role in the case of persistent atelectasis. It is also crucial to recognize the initial phase of an acute respiratory exacerbation, increase the use of these techniques which may reduce morbidity and mortality.