Cough Assist

[lisaann1170]

To piggyback on Thelma's thread about the suction machine, I'm interested in also hearing your experiences with cough assist devices.

Secretions are becoming a huge problem for my dad (in part due to long-standing sinus problems) and we're looking for solutions. His speech therapist has little experience with cough assist machines, but seems open to my suggestions.

Has anyone had any raving success with this type of device? And, could you tell me which unit you're using?

Thanks!

 

[lisaann1170]

To add to my own question, I found a thread circa 2007 on the subject.

https://www.alsforums.com/forum/general-discussion-about-als-mnd/2310-cough-assist.html

Few had great things to say about cough assist devices. Has this changed in the last two years?

 

[thelma313]

Hi Lisa, I don't know which unit my dad is using but he has not had much success with the cough assist. He gets more relief from the suction machine.

Is your dad taking anything for the secretions? My dad is getting a prescription for Atropine drops today. He is going to try those and if they don't work for him he is going to try the Scopolamine patch. The secretions really are a problem. When they build up he can barely breathe. It's so unpleasant for him. I hope something works!

All the best to you and your dad.
Rosella

 

[Tfisher]

My mom has a cough assist and a suction machine, she doesn't use the cough assist because it scares her, I think BethU said something about it sucking your face off and that's about right but we keep it around and maybe she will use it eventually. The suction on the other hand has been very helpful for my mom, she keeps it by her side daily.

Off the track.....has anyone seen those projection clocks? It projects the time and temp on the ceiling and it is not so bright that it is bothersome. I bought one for my mom and it is much easier for her to just see the time on the ceiling instead of trying to turn and look at the clock.

Rosella, How is your dad today? Going home soon?

 

[thelma313]

Tfisher, my dad had a pretty good day yesterday so we are thrilled. He barely had to suction at all. He is doing some physiotherapy for a few days and then he'll probably go home on the weekend. Keeping our fingers crossed... he has been such a trooper!

 

[asantiago]

We too struggled with the cough assist. BUT it was a good tool to have late in progression. It helped us keep her from choking a handful of occasions. Part of the problem i'm sure was just being unsure how to properly use it. I'd have the cough assist in one hand and suction in the other, it was quite the juggling act that I don't feel I ever 100% mastered. The hardest part is being a thrid party trying to know the right times to apply each. Especially considering mom couldn't talk to guide me through it. I recommend you get it and see if you can get a really good tutorial on it.

 

[lisaann1170]

Rosella,

How is your dad's lung function? I made a few phone calls about the cough assist and suction devices today to deal with the secretions, and I was told that because Dad's lung function is statistically very high, the cough assist wouldn't be appropriate.

To answer your question about medication, he is taking Robinul (glycopyrrolate) for the secretions. It hasn't helped. He has long-standing issues with his sinuses, so I fear that's part of the issue.

I'm happy to hear that your dad is doing better! Best to you!

 

[thelma313]

Lisa,

My dad's FVC is at 47%. He just had that checked a week and a half ago. Will keep you posted on how the Atropine works for him.

Keep doing what your doing!

From one daughter to another,
Rosella

 

[brooksea]

Lisa,

It amazes me how different clinics vary in their opinions about assistive devices!

The RTs at Emory Clinic hounded my husband about using his cough assist daily (twice daily). His FVC is near 100%. It helps to remove gunk stuck in the airway and expands your lungs.

He used it religiously a while back when he had pneumonia and then when he was suffering from allergies/cold.

You can adjust the settings. The RT showed my husband how to use it.

I would think having it on hand could be of benefit, especially if you become ill with respiratory infection, no matter the FVC. Of course, this is just my opinion.

 

[asantiago]

I agree with brooksea, my mom got her machine before she experienced a decrease in pulmonary fuction. It is useful for clearing the airway when the throat muscles start weakening.

 

[KeeKer]

Rosella, keeping my fingers crossed that your dad can come home on the weekend.

 

[newbie]

Re: Cough Assist - love it!

My husband got a cough assist machine summer 2008 when he had a chest cold and was nearly drowning. The ALS pulmonologist and resp. therapist met us at the ER and got things under control using the cough assist machine. The RT spent about 30 minutes with us and sent the machine home with us. My hubby used it initially only to clear gunk, but then found it would also pull out plugs of food that went down the wrong way... it was a decent substitute for a heimlech maneuver, when we were at home anyway. Hubby continued to eat against medical advice so we set the machine up right by his chair and he continued to enjoy soft versions of his favorite foods. As his lung function decreased, the doctor recommended using it twice a day just to keep his lungs in as good condition as possible.

It takes a while to get the hang of it. Over time, you will learn to hear the difference and know when to use just the exhale vs inhale/exhale. We used it on automatic for a while, adjusting the duration of both inhale/exhale and the duration of the pause inbetween. We found the settings that weren't too uncomfortable but were still effective, and marked the machine with a Sharpie. The knobs can get bumped and it seems like the machine isn't working and it happens just when there's a crisis. So, mark the settings and it's easy to spot when the knobs have gotten off of the correct settings. If it was just some deep phlegm causing a problem, that was too deep to get with suction, we used cough assist on inhale/exhale. If it was food, we flipped it to manual and used exhale only because you don't want to push plugs and particles further down. Hubby would put on for 2 or 3 seconds, take a break for 1 or 2 seconds, and then do it again, and keep doing it until the food got up to the back of his throat. With Bulbar Onset, he lost the ability to move his tongue so couldn't move the food forward enough to spit it out - here's where the suction machine helped.

You need both machines really. Keep trying. The skill level in using cough assist will come with experience. We eventually got our own. We've even traveled with it, take it on a suitcase trolly to friends houses when we were going to have a meal, borrowed an older version (louder but smaller) from the local hospital and took it on a 3,000 mile flight in a carry on bag (with wheels). He couldn't use it on the plane, there are no plugs, so he used liquid nutrition through the PEG tube for the duration of the flight.
Your ear will learn to hear the difference to know which machine to grab and what settings to use. Suction works well for mouth and back of throat, but when it's below the epiglottis, cough assist is the only thing that works.

Good luck!

 

[pamnandy]

I was curious about your responses to this thread, as it seems that some PALS get more use out of it than others. Andy used his until his lung function went down below about 40%. Then he felt it wasn't helping him anymore. We found that a heimlich-like push on his diaphram was more productive and brought more stuff up. I think everyone who has access to a cough assist should try it though, or at least have it available. I remember using it in desperation once when he was choking, and it helped.

We didn't use suction until he couldn't cough the stuff up all the way anymore. I never did get the hang of the flexible tube and just used the mouth thingy. It sure did help for those pieces of phlegm that were in the back of his throat that couldn't get up into his mouth. We also used it in his nose when he couldn't blow anymore. I would seal one side with my finger and use the wand thingy in his other nostril. Wow, he loved getting all that out of his sinuses and nose. Sometimes we'd use it after moistening with saline, if he'd have some dry stuff up there.

The best mucus thinner for Andy was Mucinex. He also used Robinal, but that was later on in his progression. His doctor had him start on Mucinex pretty early on. He did have some allergies to something in the air, which seemed to magnify with the onset of the disease, and Mucinex thinned out whatever he was coughing up, therefore making it easier.

Blessings,
Pam