Cough assist machines

What are cough assist machines?

 The mechanical insufflator/exsufflator (MI-E/ Cough Assist machine) assists the clearance of bronchopulmonary secretions in those patients with an ineffective cough by the use of both positive and negative pressure.

The MI-E (Cough Assist Machine) is a non-invasive therapy that safely and consistently removes secretions in patients with an ineffective ability to cough (measured by peak cough flow <270 l/m). The Cough Assist device 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, creating an effective cough by significantly increasing peak cough flow, which improves airway clearance and removes bronchopulmonary secretions, thereby preventing and reducing respiratory tract infections.

Respiratory function should be assessed in people with complex care needs by a Specialist Ventilation MDT that includes consultants with a special interest in ventilatory support/weaning, physiotherapists, specialist ventilation nurses.  The MDT may include palliative care and speech and language clinicians. 

All patients being considered for a cough assist device should be discussed with the Local Respiratory Specialist Team, however ONLY the Specialist Ventilation MDT may assess and apply for funding for a cough assist machine for the patient. However, once funding has been secured, the local Respiratory Specialist Team may provide assessment, on-going monitoring and support to the patient. If annual funding renewal is required, then review with the Specialist Ventilation MDT will be required to ensure that use of the device remains clinically indicated in the patient.

N.B the Specialist Ventilation MDT will need to be ratified by the CCG as an appropriate centre, with an appropriately skilled MDT prior to funding applications being accepted by the CCG.

Benefits of cough assist

  • Removes secretions from the lungs
  • Reduces the occurrence of respiratory infections and the ensuing requirement for antibiotics
  • Supports a patient to avoid hospitalisation and need for intubation and tracheostomy
  • Recruits lung volume and prevents atelectasis
  • Decreases the risk of patient mortality
  • Safe, non-invasive 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

Eligibility criteria

The patient must be diagnosed with one of the following conditions:

  • Motor Neurone Disease
  • Spinal Muscular Atrophy
  • Spinal cord injury
  • Multiple Sclerosis
  • Guillain-Barre Syndrome
  • Post polio syndrome with respiratory impairment
  • Kypho-scoliosis
  • Syringomyelia
  • Other neuromuscular disease which is known to cause respiratory muscle weakness or upper airway functional impairment.

AND

In line with the above diagnosis the patient must also be unable to cough or clear secretions effectively:

  • PCF (Peak Cough Flow) less than 160 L/min AND
  • VC (vital capacity) below 1.1L in general respiratory muscle weakness, AND
  • Reduced Peak Cough Flow (PCF) of 270 l/pm or < 270 l/pm and have clinical symptoms or a weak cough and therefore require intervention necessary to clear bronchial secretions or infection

AND

The patient must be assessed and continue to be monitored by a specialist ventilation team with expert clinical knowledge and experience in the use of Cough Assist machines.

AND

Prior approval for funding must be sought for a cough assist machine to be provided in the community prior to the patient being supplied with a Cough Assist machine. For each patient funded with a Cough Assist Machine the provider should provide a written annual update by the specialist ventilation team to evidence that continuation of treatment is clinically effective before the next year of funding will be continued.

Contraindications to treatment with a Cough Assist Machine

The specialist ventilation team will individually assess each patient prior to commencing treatment with a cough assist machine and consider all contraindications before use.

These could include:

  • Any patient with a history of bullous emphysema
  • Susceptibility to pneumothorax or pnuemo-mediastinum

This means (for patients who DO NOT meet the above criteria) the CCG will only fund the treatment if an Individual Funding Request (IFR) application proves exceptional clinical need and that is supported by the CCG.

Treatment policy for patients covered by NHS Birmingham and Solihull CCG