Abstract
Coughing is the primary defence mechanism against foreign bodies in the central airways and can quantitatively be assessed by cough peak flow (CPF). We conducted a narrative review of the literature on CPF, which is most commonly used for evaluating cough strength. This review regards the method for measurement of CPF, the cough-related factors influencing CPF, the clinical significance of CPF evaluation, and a novel cough strength prediction method using cough sounds. Furthermore, this review presents various cutoff thresholds that predict extubation failure in patients on mechanical ventilation, acute respiratory failure, and aspiration risk. The published clinical evidence of CPF demonstrates reasonable diagnostic accuracy, predictive power, and validity, although additional studies on the non-contact measurement of CPF via cough sounds with better-quality methodologies are required.
Highlights
Previous data have shown that 60% of community-acquired pneumonia and 87% of hospital-acquired pneumonia patients are diagnosed with aspiration pneumonia [1]
Recent studies have reported that mechanical insufflation–exsufflation (MIE) exsufflation flow (MIE-EF) correlates with upper airway patency [43,44] and that a successful transition from invasive to noninvasive respiratory management requires an MIE exsufflation (cough) flow (MIE-EF) value of at least 150 to 200 L/min [44]
Several guidelines recommend that cough assist techniques should be used in patients with neuromuscular disease when their cough peak flow (CPF) is below 270 L/min [8,39] because Duchenne muscular dystrophy (DMD) patients are at risk of developing acute respiratory failure when their CPF is below 270 L/min [35]
Summary
Previous data have shown that 60% of community-acquired pneumonia and 87% of hospital-acquired pneumonia patients are diagnosed with aspiration pneumonia [1]. Many guidelines for the respiratory management of patients with neuromuscular disease have been published by various academic societies and recommend CPF measurement. The British Thoracic Society guidelines for the respiratory management of children. The British Thoracic Society guidelines for the respiratory management of children with neuromuscular weakness recommended that. CPF should used part the assessment with neuromuscular weakness recommended that should bebe used asas part ofof the assessment ofof effective secretion clearance in children with neuromuscular disease over years of age [8]. Effective secretion clearance in children with neuromuscular disease over 12 years of age [8]. This review explains the measurement and evaluation method of of asas a reflection ofof cough strength, its related factors, and its clinical significance. A non-contact measurement strength, its related factors, and its clinical significance.
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