Monitoring cough effectiveness and use of airway clearance strategies: A Canadian and UK survey

Abstract

BACKGROUND: Regular monitoring combined with early and appropriate use of airway clearance can reduce unplanned hospital admissions for patients with neuromuscular disease (NMD) and spinal cord injury (SCI). We aimed to describe and compare knowledge of guidelines, monitoring of cough effectiveness, clinician prescription/provision of airway clearance strategies, and service provision constraints in the United Kingdom and Canada. METHODS: This was a cross-sectional survey of clinicians affiliated with NMD and SCI clinics in Canada, 2016 attendees at the Home Mechanical Ventilation Conference in the United Kingdom, and United Kingdom physiotherapist networks. RESULTS: We received 155 surveys (92 from Canada; 63 from the United Kingdom). More UK respondents (76%) were aware of airway clearance guidelines than Canadian (56%) respondents (P =.02). Routine assessment of cough effectiveness was reported by more UK respondents (59%) than Canadian (42%) respondents (P =.044). Cough peak flow (CPF) was the most common method used in both countries, although it was more commonly used in the UK (96%) than in Canada (81%, P =.02). Fewer Canadian respondents reported using CPF before initiation of airway clearance (81% vs 94%, P =.046), and fewer Canadian respondents showed results to patients for technique feedback (76% vs 97%, P =.007). Similar participant numbers reported using CPF after initiation to ensure adequate technique (73% vs 72%, P =.92). Mechanical insufflation-exsufflation (MI-E) ± lung volume recruitment (LVR) ± manually assisted cough when CPF < 270 L/min was most routinely recommended (41% overall). Monotherapy was infrequent (LVR 15%, manually assisted cough 7%, and MI-E 4%). More Canadians identified constraints on service provision, specifically insufficient public funding for equipment (68% vs 39%, P =.002) and inadequate community workers’ knowledge (56% vs 34%, P =.002). Funding for community support was a common constraint in both countries (49% vs 42%). CONCLUSIONS: The somewhat variable cough effectiveness monitoring and airway clearance practices identified in this survey confirm the need for further work on knowledge translation related to guideline recommendations and the need to address common constraints to optimal service delivery.