Cited by 326Cystic Fibrosis Research AdvancesRespiratory and Cough-Related ResearchRespiratory Support and Mechanisms

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Airway clearance techniques in neuromuscular disorders: A state of the art review

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Chatwin, Michelle, Toussaint, Michel, Gonçalves, Miguel R., Sheers, Nicole, Mellies, Uwe, Gonzales-Bermejo, Jesus, Sancho, Jesus, Fauroux, Brigitte, Andersen, Tiina, Hov, Brit, Nygren-Bonnier, Malin, Lacombe, Matthieu, Pernet, Kurt, Kampelmacher, Mike, Devaux, Christian, Kinnett, Kathy, Sheehan, Daniel, Rao, Fabrizio, Villanova, Marcello, Berlowitz, David, Morrow, Brenda M.·2018·Respiratory Medicine

DOI 10.1016/j.rmed.2018.01.012

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Abstract

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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Berlinger, M. S., & Lechtzin, N. (2024) · Respiratory medicine · doi:10.1007/978-3-031-65335-3_10
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Expiratory Muscle Training in Motor Neuron Diseases: Impact on the Upper Airways
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One Step Closer to Personalized Management of Neuromuscular Respiratory Failure
Fox, T. H., & Choi, P. J. (2025) · CHEST Journal · doi:10.1016/j.chest.2024.09.008
Respiratory Rehabilitation for Neuromuscular Diseases
Asakawa, T. (2024) · リハビリテーション医学 : 日本リハビリテーション医学会誌 · doi:10.2490/jjrmc.61.1169
Outcomes and measures in studies of techniques to promote secretion clearance in individuals with neuromuscular conditions: a scoping review
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“Proximal techniques include assisted inspiration ( e.g. air stacking, glossopharyngeal breathing, lung volume recruitment), assisted expiration ( e.g. manually assisted cough) and assisted inspiration and expiration ( e.g. mechanical insufflation – exsufflation) [9].”
Influential
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Self-citation
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Management of Secretions and Augmentation of Coughing in Diseases of the Nervous System and the Muscles
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“91 Airway clearance plays a crucial role in postoperative management and operates in conjunction with NIV.”
Ventilación mecánica prolongada y paciente traqueostomizado en cuidados intensivos pediátricos
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Acute Effects of Mechanical Insufflation-Exsufflation on Cough Peak Flow, Chest Wall Volumes, and Breathing Pattern of Patients With Amyotrophic Lateral Sclerosis
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Additional file 2 of Mechanical insufflation-exsufflation to promote extubation success in critically ill adults on intensive care: protocol for a randomised controlled feasibility trial
Swingwood, E. L., Voss, S., Tume, L. N., Bewley, J., Turner, N., Ntoumenopoulos, G., Rose, L., & Cramp, F. (2023) · Figshare · doi:10.6084/m9.figshare.23740608
Additional file 1 of The effect of respiratory muscle training on children and adolescents with cystic fibrosis: a systematic review and meta-analysis
Cai, W., Li, M., Xu, Y., Li, M., Wang, J., Zuo, Y., & Cao, J. (2024) · Figshare · doi:10.6084/m9.figshare.25608780
Additional file 1 of Multiple breath washout lung function reveals ventilation inhomogeneity unresponsive to mechanical assisted cough in patients with neuromuscular disease
Steindor, M., Pichler, A., Heitschmidt, L., Pitsikoulis, E., Kavvalou, A., Orhan, E., Olivier, M., & Stehling, F. (2022) · Figshare · doi:10.6084/m9.figshare.20004720
Additional file 1 of Peri-partum respiratory management of pregnant women with neuro-muscular disorders: a prospective observational study (IT-NEUMA-Pregn study)
Racca, F., Longhitano, Y., Zanza, C., Balzanelli, M. G., Draisci, G., Stoia, P. A., Gollo, E., Maio, M., Grattarola, C., Astuto, M., et al. (2024) · Figshare · doi:10.6084/m9.figshare.26626564
Additional file 3 of Effect of a prolonged slow expiration technique on 24-h food intake in children hospitalized for moderate bronchiolitis: a randomized controlled trial
Combret, Y., Machefert, M., Couet, M., Bonnevie, T., Gravier, F.-E., Gillot, T., Roux, P. L., Hilfiker, R., Médrinal, C., & Prieur, G. (2024) · Figshare · doi:10.6084/m9.figshare.27123985
Additional file 1 of Mechanical insufflation-exsufflation to promote extubation success in critically ill adults on intensive care: protocol for a randomised controlled feasibility trial
Swingwood, E. L., Voss, S., Tume, L. N., Bewley, J., Turner, N., Ntoumenopoulos, G., Rose, L., & Cramp, F. (2023) · Figshare · doi:10.6084/m9.figshare.23740605
Additional file 1 of Effect of a prolonged slow expiration technique on 24-h food intake in children hospitalized for moderate bronchiolitis: a randomized controlled trial
Combret, Y., Machefert, M., Couet, M., Bonnevie, T., Gravier, F.-E., Gillot, T., Roux, P. L., Hilfiker, R., Médrinal, C., & Prieur, G. (2024) · Figshare · doi:10.6084/m9.figshare.27123979

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: Toussaint, Michel
Gonçalves, Miguel R.
Sheers, Nicole
Sancho, Jesus
Fauroux, Brigitte
Andersen, Tiina
Hov, Brit
Nygren-Bonnier, Malin
Kinnett, Kathy
Rao, Fabrizio
Villanova, Marcello
Berlowitz, David
Morrow, Brenda M.
Venue: Respiratory Medicine
Publisher: Elsevier BV
Published: 2018-03
Volume: 136
Pages: 98-110
ISSN: 0954-6111 (ISSN-L)
DOI: 10.1016/j.rmed.2018.01.012
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: cc-by-nc-nd
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
creativecommons.org/licenses/by-nc-nd/4.0/ (vor)
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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Airway clearance techniques in neuromuscular disorders: A state of the art review

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