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Airway clearance techniques in neuromuscular disorders: A state of the art review
Open accessAbstract
This is a unique state of the art review written by a group of 21 international recognized experts in the field that gathered during a meeting organized by the European Neuromuscular Centre (ENMC) in Naarden, March 2017. It systematically reports the entire evidence base for airway clearance techniques (ACTs) in both adults and children with neuromuscular disorders (NMD). We not only report randomised controlled trials, which in other systematic reviews conclude that there is a lack of evidence base to give an opinion, but also include case series and retrospective reviews of practice. For this review, we have classified ACTs as either proximal (cough augmentation) or peripheral (secretion mobilization). The review presents descriptions; standard definitions; the supporting evidence for and limitations of proximal and peripheral ACTs that are used in patients with NMD; as well as providing recommendations for objective measurements of efficacy, specifically for proximal ACTs. This state of the art review also highlights how ACTs may be adapted or modified for specific contexts (e.g. in people with bulbar insufficiency; children and infants) and recommends when and how each technique should be applied.
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“As shown by Chatwin, normal trans tracheal suctioning with a catheter is not completely effective in more than 90% of cases and thus peripheral secretions are not removed [52].”
From Life Experiences in Neuromuscular Tracheotomized Patients in Times of Covid-19 (2023) · cites this paper as [52]
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“Available recommendations planning MI-E therapy prior to meals seem appropriate [4, 10].”
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“64,65 However, recent data demonstrate that high pressure MIE generates more upper airway closure than low pressure MIE, which is missed if PCF is used as a sole titration target for clinical effectiveness.”
BackgroundSancho, J., Burés, E., Ferrer, S., Lahosa, C., Signes‐Costa, J., & Servera, E. (2020) · Respiratory Care · doi:10.4187/respcare.08145 · Cited by 7
“5 In this regard, MI-E has greater efficacy than suctioning in removing respiratory secretions and improving ventilator and mechanical parameters.”
Self-citationHighlights from the Respiratory Failure and Mechanical Ventilation 2020 Conference
Withers, A., Choi, T. C. M., D'Cruz, R. F., de Vries, H. J., Fisser, C., Ribeiro, C. S. M. F., Shah, N. M., Hollebeke, M. V., Vosse, B. A. H., Heunks, L. M. A., et al. (2021) · ERJ Open Research · doi:10.1183/23120541.00752-2020 · Cited by 9
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“Cough efficacy with mucus expectoration has been defined with values above 160– 200 L/min (Chatwin et al., 2018).”
BackgroundThe role of respiratory therapy in rib fracture management
Anderson, T. N., Wang, S., Free, D., & Forrester, J. D. (2024) · Current Problems in Surgery · doi:10.1016/j.cpsurg.2024.101664 · Cited by 6
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“Such patients need external support for the extraction of mucus from the proximal airways (5).”
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“Quantitative assessment of cough capacity is typically conducted by measuring PCF, but there are currently no internationally accepted guidelines for PCF testing [40].”
Ansaripour, A., Roehrich, K., Mashayekhi, A., Wanjala, M., Noel, S., Hemami, M. R., Murray, A., & Javanbakht, M. (2021) · PharmacoEconomics - Open · doi:10.1007/s41669-021-00299-y · Cited by 6
“HFCWO devices facilitate airway clearance by providing appropriate secretion movement and reduce mucous viscosity [1, 4, 5] in diseases such as cNMD.”
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Perioperative management of patients with neuromuscular diseases. Guidelines
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“9, a noted with concern “ The lack of a comprehensive accessibility strategy to harmonize accessibility obligations at the federal, cantonal and municipal levels, to embed universal design standards and to encompass all domains, including public transport, buildings, facilities, public spaces,…”
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York, J. D., & Troche, M. S. (2024) · Frontiers in Rehabilitation Sciences · doi:10.3389/fresc.2024.1394110 · Cited by 7
Effects of mechanical insufflator-exsufflator in people with spinal cord injury: a systematic review
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“4 12-14 Despite this, therapists are expected to use this tool in clinical care with patients who are unwell and complex.”
Racca, F., Longhitano, Y., Zanza, C., Balzanelli, M. G., Draisci, G., Stoia, P. A., Gollo, E., Maio, M., Grattarola, C., Astuto, M., et al. (2023) · BMC Anesthesiology · doi:10.1186/s12871-023-02307-6 · Cited by 5
“…MI-E were performed only in case of diurnal or nocturnal hypercapnia, FVC 30% of predicted value or PCF 270 L/min.. Mechanical insufflation-exsufflation (MI-E) is a technique used to optimize airway clearance in patients who have an impaired cough reflex due to respiratory muscle weakness [27].”
MethodAccuracy of Real-Time Data Provided by Mechanical Insufflation-Exsufflation Devices
Martínez-Alejos, R., Fresnel, E., Vuillermoz, A., Beloncle, F., & Lebret, M. (2024) · Respiratory Care · doi:10.4187/respcare.12221 · Cited by 5
“3,14 Recent literature has highlighted the limitations of relying solely on MI-E – assisted PEF due to signal processing issues in these devices.”
InfluentialRespiratory concerns in children with medical complexity
DellaBadia, K., & Tauber, D. (2021) · Current problems in pediatric and adolescent health care · doi:10.1016/j.cppeds.2021.101072 · Cited by 5
Will the Addition of Oscillations in Mechanical Insufflation-Exsufflation Ever Be Beneficial?
Chatwin, M., & Toussaint, M. (2020) · Respiratory Care · doi:10.4187/respcare.07798 · Cited by 5
“Therefore, in its “true” form, MI-E is a proximal airway clearance strategy, and oscillatory therapies are peripheral airway clearance strategies.(14,15) MI-E consists of an increase in the inspiratory volume followed by an increase in expiratory air flow that is enhanced by negative pressure, which simulates what occ…”
BackgroundSelf-citationExpanded central role of the respiratory physiotherapists in the community setting
Duignan, N., Ridge, P., Leonard, S., McDonnell, M. J., Cusack, R. P., Harrison, M., Rutherford, R. M., O’Malley, N., & Dolan, C. (2022) · Irish Journal of Medical Science (1971 -) · doi:10.1007/s11845-022-03213-5 · Cited by 4
“They are particularly useful in the setting of acute infection [29].”
Background2022 Year in Review: Mechanical Insufflation-Exsufflation
Willis, L. D. (2022) · Respiratory Care · doi:10.4187/respcare.10423 · Cited by 4
“64 Individuals with profound muscle weakness may be unable to hold the mouthpiece, obtain a good seal, or prevent air from escaping through the nose.”
Racca, F., Sansone, V., Ricci, F., Filosto, M., Pedroni, S., Mazzone, E. S., Longhitano, Y., Zanza, C., Ardissone, A., Adorisio, R., et al. (2022) · Acta myologica : myopathies and cardiomyopathies : official journal of the Mediterranean Society of Myology / edited by the Gaetano Conte Academy for the study of striated muscle diseases · doi:10.36185/2532-1900-081 · Cited by 4
Self-citationHyun, S. E., Hwang, W., Ji, H. M., & Shin, H. (2023) · Scientific Reports · doi:10.1038/s41598-023-43256-x · Cited by 4
“…or lung barotrauma within 1 month; had any active communicable respiratory infections; were hemodynamically unstable, i.e., systolic blood pressure < 90 or > 160 mmHg, diastolic blood pressure < 50 or > 110 mmHg, respiratory rate > 33/min, heart rate > 130 bpm, or saturation (SpO2) < 95% 7,23 .”
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“21 Statement : The PEP mask may be useful in patients with frequent respiratory infections secondary to poor mobilization of respiratory secretions from the lower airways.”
BackgroundInspiratory muscle training in severe spinal muscular atrophy: a case report
Human, A., Honey, E. M., & Morrow, B. M. (2019) · International Journal of Therapy and Rehabilitation · doi:10.12968/ijtr.2017.0108 · Cited by 4
Self-citationNon-Invasive Ventilation for Acute Respiratory Failure in Duchenne Muscular Dystrophy Patients
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“Mechanical insufflation-exsufflation (MI-E) augments inspiratory and expiratory flow to improve secretion mobilisation, through rapidly alternating positive and negative pressure, approximating a normal cough [6].”
BackgroundRehabilitation in children with home invasive mechanical ventilation
Genç, A., & Tur, B. S. (2024) · Pediatric Pulmonology · doi:10.1002/ppul.26872 · Cited by 4
“20 Skeletal muscle dysfunction due to physical inactivity is an important cause of exercise intolerance and failure to perform activities of daily living.”
Mechanical Insufflation-Exsufflation: More Than Just Cough Assist
Benditt, J. O. (2018) · Respiratory Care · doi:10.4187/respcare.06439 · Cited by 4
Pradon, J., Barzic, A., Lavadera, M. L., Khirani, S., Canavesio, C., Fleurence, E., Labouret, G., Aubertin, G., Denamur, S., & Taytard, J. (2025) · Respiratory Medicine · doi:10.1016/j.rmed.2025.108183 · Cited by 3
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Managing Cough in Pediatric Neuromuscular Disorders: Lung Function and Care Strategies
Randazzese, S. F., Fenu, G., Calogero, C., Lombardi, E., & Manti, S. (2025) · Children · doi:10.3390/children12101377 · Cited by 3
“Once the patient reaches near TLC, a cough is initiated, either spontaneously or with MAC [38,60,68,69].”
InfluentialRespiratory Dysfunction and Management in Spinal Cord Injuries
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“A consensus of experts in the field recommends using a facemask to evaluate PCF efficacy in neuromuscular disease, to reduce the occurrence of air leak from a mouthpiece.(42) The EMG vector analysis identified trends toward greater EMG Mag and SI when completing PCF with a Fig.”
BackgroundUpper airway assessment and its implications for interventions by respiratory physiotherapists
Ntoumenopoulos, G., Andersen, T. M., & Hardingham, N. (2022) · Physiotherapy Theory and Practice · doi:10.1080/09593985.2022.2106916 · Cited by 3
“…effects on quality of life (Cazzolli and Oppenheimer, 1996) and a greater burden of caregiving and financial costs (Bach, 1993; Borasio, Gelinas, and Yanagisawa, 1998; Chatwin et al., 2018; Lechtzin et al., 2006; Miller et al., 1999; Sivak, Cordasco, and Gipson, 1983; Tandan and Bradley, 1985).”
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“Peak cough expiratory flow (PCEF) was obtained according to standard procedures [21], with the patient in the sitting position and the therapist supporting the mask on the patient’s face.”
MethodAsakawa, T., Ogino, M., Tominaga, N., Ozaki, N., Kubo, J., & Kakuda, W. (2023) · Neurology International · doi:10.3390/neurolint15040077 · Cited by 3
“PCF represents the maximum expiratory flow during coughing and is one of the simple cough function evaluations [14].”
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Duprez, F., Crombin, M., Daubechies, I., Devries, N., Durant, V., Khalil, M. E., & Audag, N. (2023) · Revue des Maladies Respiratoires · doi:10.1016/j.rmr.2023.10.006 · Cited by 3
Management of neurological problems in children on home invasive mechanical ventilation
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“5,7,8 .”
Lung volume recruitment and airway clearance for children at home in France
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Self-citationShah, N. M., Madden-Scott, S., Apps, C., Swingwood, E. L., Shannon, H., Suh, E., Hart, N., Kaltsakas, G., Osman, L., & Murphy, P. B. (2025) · Respiratory Care · doi:10.1089/respcare.12514 · Cited by 3
“5,6 CPF values are used clinically to categorize a cough as effective (CPF > 270 L/min), ineffective (CPF 160 – 270 L/min), or severely ineffective (CPF 160 L/min).”
Netto, C. B., Reboredo, M. M., Vieira, R. S., da Fonseca, L. M. C., Júnior, E. C., de Souza, A. L. D., Carvalho, E. V., & Pinheiro, B. V. (2025) · Medicina Intensiva · doi:10.1016/j.medin.2024.502125 · Cited by 3
Cough augmentation techniques for people with chronic neuromuscular disorders
Morrow, B. M., Argent, A. C., Zampoli, M., Human, A., Corten, L., & Toussaint, M. (2018) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd013170 · Cited by 3
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Self-citationLife Experiences in Neuromuscular Tracheotomized Patients in Times of Covid-19
Volpato, E., Pierucci, P., De Candia, M. L., Casparrini, M., Volpi, V., Pagnini, F., Carpagnano, G. E., & Banfi, P. (2023) · Journal of Neuromuscular Diseases · doi:10.3233/jnd-221597 · Cited by 2
“As shown by Chatwin, normal trans tracheal suctioning with a catheter is not completely effective in more than 90% of cases and thus peripheral secretions are not removed [52].”
BackgroundKinimi, I., Sahoo, A., Shinde, S. S., Rao, N. M., Mohandass, G., Tauro, R., Adiga, D., Aramanadka, R., Ram, A., & Shamrao, S. (2024) · Journal of Pediatric Pulmonology · doi:10.4103/jopp.jopp_62_23 · Cited by 2
Reychler, G., Audag, N., Prieur, G., Poncin, W., & Contal, O. (2024) · Revue des Maladies Respiratoires · doi:10.1016/j.rmr.2024.06.001 · Cited by 2
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Saito, Y., Arai, Y., Omae, T., Watanabe, K., Saiki, Y., Tanaka, T., Hosoda, C., Tamasaki-Kondo, A., Maegaki, Y., & Okada, K. (2025) · Brain and Development · doi:10.1016/j.braindev.2024.104317 · Cited by 2
Managing Spinal Muscular Atrophy: A Look at the Biology and Treatment Strategies
Vezzoli, A., Bottai, D., & Adami, R. (2025) · Biology · doi:10.3390/biology14080977 · Cited by 2
“This technique is particularly effective in mobilizing secretions and preventing mucus plugging [117,118].”
Ribeiro, C. S. M. F., Gomes, R., Carreiro, A., Vieira, A. L., Seabra, B. C., Conde, B., Nogueira, C., Jácome, C. I. O., Lages, J., Aguiar, M., et al. (2025) · Pulmonology · doi:10.1080/25310429.2025.2598915 · Cited by 2
Self-citationAirway clearance techniques – a proposed classification based on definitions?
Reychler, G., Audag, N., Prieur, G., Poncin, W., & Contal, O. (2026) · Expert Review of Respiratory Medicine · doi:10.1080/17476348.2026.2626079 · Cited by 2
“All cough assistance techniques aim to increase as much as possible peak cough flow [18,19] (Figure 4(B)) and are selected based on the patient’s values.”
Stoian, M., Demenciuc, N., Laszlo, S. Ș., Moțățăianu, A., Babă, D.-F., & Stoian, A. (2026) · The Journal of Critical Care Medicine · doi:10.2478/jccm-2026-0004 · Cited by 2
“Effective secretion clearance is a key determinant of survival and quality of life in ALS patients with IMV [15,16].”
Médrinal, C., Delemazure, J., Billard, M., Carpentier, D., Choukroun, G., Combret, Y., de Crouy, A.-C., López, C. D., Dugernier, J., Farcy-Afif, M., et al. (2026) · Annals of Intensive Care · doi:10.1016/j.aicoj.2026.100045 · Cited by 2
“MI-E delivers positive-pressure insufflation immediately followed by negative pressure to generate rapid expiratory flow and assist sputum clearance [95].”
Aides instrumentales mécaniques au désencombrement : définition, aide aux réglages et indications
Poncin, W., Lebret, M., & Maerckx, G. (2022) · Revue des Maladies Respiratoires · doi:10.1016/j.rmr.2022.04.006 · Cited by 2
Effect of the Inspiratory Method and Timing of Voluntary Cough on Peak Cough Flow
Kotajima, F., Yatomi, M., & Hisada, T. (2023) · Annals of Rehabilitation Medicine · doi:10.5535/arm.22103 · Cited by 2
“In recent years, peak cough flow (PCF) has been used as an objective measure of voluntary coughing ability, as reported in the literature [2-5].”
MethodEmotions experienced by parents whose children have spinal muscular atrophy: A qualitative research
Şimşek, D. C., & Çetin, K. D. K. (2024) · Journal of Pediatric Nursing · doi:10.1016/j.pedn.2024.11.027 · Cited by 2
Yorimoto, K., Ariake, Y., Kawaguchi, T., & Hara, T. (2025) · BMJ Case Reports · doi:10.1136/bcr-2024-262945 · Cited by 2
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“CPF, the second parameter, measures maximal expiratory airflow velocity during a coughing episode and provides predictive value in terms of the patient’s ability to effectively clear their airway of tracheal aspirate during swallowing and salivary secretion 13,27 .”
Tsampalieros, A. K., Mckim, D. A., Barrowman, N., Bijelić, V., Mah, J. K., McMillan, H. J., Campbell, C., Momoli, F., Blinder, H., McAdam, L. C., et al. (2025) · Annals of the American Thoracic Society · doi:10.1513/annalsats.202404-360oc · Cited by 2
Massey, C., Hobson, E., Griffiths, A. W., Musson, L. S., & McDermott, C. J. (2025) · Neurodegenerative Disease Management · doi:10.1080/17582024.2025.2506954 · Cited by 2
“Cough and secretion management in ALS usually involves an airway clearance technique to augment cough strength due to respiratory muscle weakness [18,19], pharmacological management of oropharyngeal and respiratory secretions and/or other treatments such as optimizing posture and positioning or…”
Massey, C., Griffiths, A. W., McDermott, C. J., & Hobson, E. (2025) · Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration · doi:10.1080/21678421.2025.2522401 · Cited by 2
“This includes airway clearance strategies, both proximal (cough augmentation) and peripheral (secretion mobilising) (8), and pharmacological support.”
Prise en charge en kinésithérapie des patients atteints de sclérose latérale amyotrophique
Ramos, C. (2019) · Pratique Neurologique - FMC · doi:10.1016/j.praneu.2019.07.003 · Cited by 2
La ventilation par embout buccal dans les maladies neuromusculaires
Chatwin, M., Gonçalves, M., Gonzalez‐Bermejo, J., & Toussaint, M. (2020) · médecine/sciences · doi:10.1051/medsci/2020271 · Cited by 2
Self-citationUso del asistente mecánico de la tos en sujetos neuromusculares pediátricos en el domicilio
Mozzoni, J., & Gómez, S. (2020) · Argentinian Journal of Respiratory & Physical Therapy · doi:10.58172/ajrpt.v2i2.106 · Cited by 2
Non-invasive ventilation of the lungs in neuromuscular diseases
Rushkevich, Y. N., Haliyeuskaya, O. V., Kulikova, Y. S., Chechik, N. M., & Sa, L. (2021) · S S Korsakov Journal of Neurology and Psychiatry · doi:10.17116/jnevro202112108177 · Cited by 2
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Combret, Y., Machefert, M., Couet, M., Bonnevie, T., Gravier, F., Gillot, T., Roux, P. L., Hilfiker, R., Médrinal, C., & Prieur, G. (2024) · The Italian Journal of Pediatrics/Italian journal of pediatrics · doi:10.1186/s13052-024-01770-2 · Cited by 2
“The effectiveness of ACT in improving gas exchange and decreasing respiratory symptoms has been demonstrated in these groups, at least in the short term [21, 22].”
BackgroundAirway Clearance Techniques in Neuromuscular Disorders
de Oliveira, M. Q. S., & Gomes, R. (2020) · Springer eBooks · doi:10.1007/978-3-030-42998-0_9 · Cited by 2
ERS International Congress, Madrid, 2019: highlights from the Sleep and Clinical Physiology Assembly
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Giacomino, K., Hilfiker, R., Magnin, T., & Allet, L. (2021) · F1000Research · doi:10.12688/f1000research.27833.1 · Cited by 2
Giacomino, K., Hilfiker, R., Magnin, T., & Allet, L. (2022) · F1000Research · doi:10.12688/f1000research.27833.2 · Cited by 2
Toussaint, M., Gonçalves, M., & Chatwin, M. (2019) · Respiratory Care · doi:10.4187/respcare.06495 · Cited by 2
Self-citationOscillations With Mechanical Insufflation-Exsufflation in ALS: Time to Pause and Return to Basics?
Swingwood, E. L., Shah, N. M., & Rose, L. (2021) · Respiratory Care · doi:10.4187/respcare.08954 · Cited by 2
“However, evidence for use of oscillation in the neuromuscular population is sparse.(4) Sancho and colleagues(5,6) are leaders in investigating the additive effect of oscillations with MI-E.”
BackgroundEscobar, M. A. T., Navarro, E., Rositi, E. S., Obligado, R., Vulliez, G. G. M., & Vito, E. L. D. (2020) · Rehabilitación · doi:10.1016/j.rh.2020.10.009 · Cited by 1
Ansourian, A. V. C. (2024) · Argentinian Journal of Respiratory & Physical Therapy · doi:10.58172/ajrpt.v6i1.293 · Cited by 1
A CONTRIBUIÇÃO DA FISIOTERAPIA NO TRATAMENTO DA ATROFIA MUSCULAR ESPINHAL (AME): REVISÃO INTEGRATIVA
da Silva, C. H., de Souza, D. M., de Santana, J. B., & Paixão, M. D. S. (2024) · Revista Multidisciplinar do Nordeste Mineiro · doi:10.61164/rmnm.v6i1.2486 · Cited by 1
Airway Colonization in Children with Medical Complexity: Challenges and Management Strategies
Fainardi, V., Rizzo, L., Zambelli, G., Berzieri, M., Maugeri, E., Giacalone, E., Carbone, R., Pera, M. C., & Esposito, S. (2025) · Journal of Clinical Medicine · doi:10.3390/jcm14030848 · Cited by 1
Shah, N. M., Apps, C., Amin, R., Kaltsakas, G., Hart, N., Murphy, P. B., & Rose, L. (2025) · Respiratory Care · doi:10.1089/respcare.12608 · Cited by 1
“8,10 The use of heterogeneous outcomes and measurement instruments across studies leads to an inability to synthesize data, preventing the development of evidence-based practice and guidelines.”
Andersen, T. M., Nørstebø, E., & Hov, B. (2025) · Respiratory Care · doi:10.1089/respcare.12874 · Cited by 1
“2,3,6 Inconsistent adherence to guidelines for cough effectiveness monitoring has been identi fi ed as a barrier, particularly in acute care settings, 17 and the results of this survey suggest that although national initiatives have effectively disseminated MI-E knowledge, further emphasis on…”
Self-citationWasilewska, E., Wasilewski, A., Pilarska, E., Wierzba, J., Małgorzewicz, S., & Niedoszytko, M. (2025) · Orphanet Journal of Rare Diseases · doi:10.1186/s13023-025-03762-9 · Cited by 1
Gray, L. T., Sullivan, S. L., O’Brien, M., Costello, J., Plowman, E. K., & Garand, K. L. (2025) · American Journal of Speech-Language Pathology · doi:10.1044/2025_ajslp-25-00064 · Cited by 1
Indications for home mechanical ventilation in children: changes over four decades
den Oudenrijn, L. P. V., Gaytant, M. A., Arts, L. A. P., Wijkstra, P. J., van der Pol, W. L., & Veldhoen, E. S. (2025) · European Journal of Pediatrics · doi:10.1007/s00431-025-06559-x · Cited by 1
Dussah, N., Mckim, D. A., Mah, J. K., McMillan, H. J., Campbell, C., Bijelić, V., Barrowman, N. J., Momoli, F., Blinder, H., Aaron, S. D., et al. (2025) · Pediatric Pulmonology · doi:10.1002/ppul.71357 · Cited by 1
“The technique consists of 3 − 5 maximal lung inflations, which may be delivered using a hand ‐ held resuscitation bag and mouthpiece, mechanical ventilator in volume control mode or a mechanical inexsufflator [5].”
Improved Lung Function with Home Oscillation and Lung Expansion Therapy in Children: A Case Series
Hawkins, R., WEATHERS, S. L., Morton, R., O’Hagan, A. R., Stevens, E. L., Orangias, M., & Bickel, S. G. (2025) · Pediatric Allergy Immunology and Pulmonology · doi:10.1177/2151321x251394848 · Cited by 1
Alsulayyim, A. S. (2026) · Respiratory Medicine · doi:10.1016/j.rmed.2026.108757 · Cited by 2
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Audag, N., Chartier, P.-A., Lebret, M., Toussaint, M., & Reychler, G. (2026) · Physical & Occupational Therapy In Pediatrics · doi:10.1080/01942638.2026.2667357 · Cited by 1
“Coughing can be particularly exhausting in patients neuromuscular disorders (NMD) due to respiratory muscles weakness and fatigue (Chatwin et al., 2018; Kang, 2006).”
Self-citationStructural Lung Disease in Children and Adolescents With Severe Neurological Disorders
Bernard, D., Dahl, C., Salhöfer, L., Pauly, A., Steindor, M., Olivier, M., Schara, U., Welsner, M., Schweiger, B., Zensen, S., et al. (2026) · Pediatric Pulmonology · doi:10.1002/ppul.71698 · Cited by 1
“However, the progressive underlying neurological disease regularly results in progression of the respiratory muscle weakness with impaired clearance of airway secretions [8].”
Escudero-Romero, R., Engeset, M. S., Andersen, T. M., Martín‐Pintado‐Zugasti, A., Cuenca‐Zaldívar, J. N., Cabrera-Guerra, M., & Spahija, J. (2026) · Respiratory Care · doi:10.1177/19433654261454978 · Cited by 1
“11,14,34 At the same time, our results showed that higher insuf fl ation and exsuf fl ation pressures tended to result in greater PEF, aligning with physiological principles and previously published clinical data.”
Self-citation
Metadata
- Authors
- Chatwin, M., Toussaint, M., Gonçalves, M. R., Sheers, N., Mellies, U., Gonzales-Bermejo, J., Sancho, J., Fauroux, B., Andersen, T., Hov, B., Nygren-Bonnier, M., Lacombe, M., Pernet, K., Kampelmacher, M., Devaux, C., Kinnett, K., Sheehan, D., Rao, F., Villanova, M., Berlowitz, D., & Morrow, B. M.
- Affiliations
- Royal Brompton & Harefield NHS Foundation Trust (GB)
- Universidade do Porto (PT)
- Institute for Breathing and Sleep (AU)
- University of Duisburg-Essen (DE)
- Hôpital Necker-Enfants Malades (FR)
- Haukeland University Hospital (NO)
- Oslo University Hospital (NO)
- Assistance Publique – Hôpitaux de Paris (FR)
- University Medical Center Utrecht (NL)
- Association Francaise contre les Myopathies (FR)
- Women & Children's Hospital of Buffalo (US)
- University of Milan (IT)
- University of Cape Town (ZA)
- Corresponding author
- Chatwin, Michelle
- ORCID
- Venue
- Respiratory Medicine
- Publisher
- Elsevier BV
- Published
- 2018-03
- Volume
- 136
- Pages
- 98-110
- ISSN
- 0954-6111 (ISSN-L)
- OpenAlex
- W2791843842
- Cited by
- 325
- References
- 127
- Citations by year
- 2026: 31 · 2025: 45 · 2024: 45 · 2023: 58 · 2022: 45 · 2021: 35 · 2020: 29 · 2019: 26 · 2018: 11
- FWCI
- 4.51
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Respiratory Medicine (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- HAL (submittedVersion, other-oa)
- Universitätsbibliographie, Universität Duisburg-Essen (submittedVersion)
- Funders
- NIHR Respiratory Disease Biomedical Research Unit at the Royal Brompton and Harefield NHS Foundation Trust and Imperial College London
- “Investissement d’Avenir” ANR-10-AIHU 06 of the French Government
- ResMed via the Royal Brompton Hospital
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Cystic Fibrosis Research Advances
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Respiratory and Cough-Related Research
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Respiratory Support and Mechanisms
- Keywords
- airway clearance techniques, neuromuscular disorders, cough augmentation, secretion mobilization, infants and children, evidence base
- MeSH terms
- Inhalation, Cough, Humans, Lung Volume Measurements, Mucociliary Clearance, Neuromuscular Diseases, Respiration, Artificial, Respiratory Insufficiency, Respiratory Muscles
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