Mechanical Insufflation-Exsufflation Device Indications and Alternatives

Indications for Mechanical Insufflation-Exsufflation Devices

The American College of Chest Physicians (ACCP) recommends mechanical insufflation-exsufflation devices for patients with neuromuscular disease and impaired cough to prevent respiratory complications, as the inability of patients with respiratory muscle weakness to achieve high lung volumes contributes to cough ineffectiveness 1, 2, 3, 4
The American Thoracic Society (ATS) consensus statement on Duchenne muscular dystrophy strongly supports mechanical insufflation-exsufflation use in neuromuscular disease, particularly when maximal expiratory pressures are <60 cm H2O 5
Mechanical insufflation-exsufflation devices are recommended specifically when assisted peak cough flows decrease to <270 L/min in neuromuscular patients, and the device works by compensating for expiratory muscle weakness, increasing peak cough expiratory flows by more than four-fold in patients with neuromuscular disease 2, 4

For patients with cystic fibrosis and CFTR-related disorders, positive expiratory pressure (PEP) devices are recommended over conventional chest physiotherapy because they are approximately as effective, inexpensive, safe, and can be self-administered 3, 7, 8
The patient should optimize her current evidence-based regimen for CFTR-related bronchiectasis, including continuing hypertonic saline with bronchodilator pre-treatment, Aerobika (oscillating PEP device), and adding or optimizing autogenic drainage technique and huffing technique 1, 3, 4, 7, 8

In persons with airflow obstruction caused by disorders like COPD, manually assisted cough may be detrimental and should not be used, as it can decrease peak expiratory flow rate by 144 L/min 2, 3, 6, 7, 8, 10