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Oscillatory devices used in airway clearance create variable resistances generating controlled oscillating positive pressure which mobilises mucus. Mechanical insufflation-exsufflation provides a non-invasive therapy to aid secretion clearance in patients with weak cough. The Cough Assist E70 combines these concepts.
Methods
We compared standard airway clearance with the E70 in 5 patients (2M, 3F, age 19–35). All had a diagnosis of CF and a typical cough (FEV1 range 0.8–1.59 L). Implementation of this device was in response to chest wall discomfort on coughing, respiratory exacerbation or fatigue with standard therapy. Ease of expectoration, cough effort, sputum weight and patient preference were considered on initialisation and were the basis for continued use. Days of use ranged from 1 to 21. E70 pressure settings were titrated for comfort. Oscillation frequency was set at 13–15 Hz on insufflation and/or exsufflation.
Results
Average sputum weight for standard therapy was 9 (4–11 g) and for E70 17 g (4–28 g). 4 patients described reduced cough effort and increased ease of expectoration using the E70. 3 patients preferred the E70 to their standard therapy. 1 patient preferred standard therapy and 1 patient felt that the E70 supported standard therapy and would be advantageous during an exacerbation.
Conclusion
Despite the small sample size we identified that the E70 is a useful adjunct in managing secretions. In particular, patients who experience fatigue or chest wall discomfort on coughing benefited from the implementation of this device and sputum yield improved noticeably. Use of the E70 should be considered when patient participation in routine airway clearance is compromised.
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© 2015 European Cystic Fibrosis Society. Published by Elsevier Inc.
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