PURPOSE: Deep lung insufflation (DLI) for cough assistance is typically used in patients with severe respiratory restriction from neuromuscular disorders. The aim of this study was to evaluate acceptance and physiologic effects of regular DLI in subjects with mild to moderate restrictive impairment.
METHODS: Adult patients with post-polio syndrome (PPS), myotonic dystrophy (MD), and amyotrophic lateral sclerosis (ALS) with vital capacity <75% predicted and total lung capacity <80% predicted were recruited. None of the patients had used non-invasive ventilation. Subjects were taught DLI using a resuscitator-type bag and were instructed to repeat 10 DLIs during 2 to 4 separate sessions daily at home. Pulmonary function data were obtained before and after 3 months of DLI usage.
RESULTS: To date, 4 PPS, 1 ALS and 1 MD patients have completed the study. The mean baseline FVC was 2.5L (SD 0.75) or 62.4% predicted (SD 9.9), and the initial unassisted peak cough flow (PCF) was 382.5 L/min (SD 96.9). PPS, ALS and MD subjects performed DLIs during a mean of 3.2 (SD 1.1), 3, and 0 sessions per day, respectively. For PPS subjects, the assisted (with maximum insufflation) PCF increased by a mean of 19.8 % (SD 17.4, p=0.08) and the unassisted PCF by a mean of 12.3% (SD 20.1, p=0.07). Excluding the non-compliant MD subject, the unassisted PCF increased by a mean of 66 L/min (p=0.06). The maximum insufflation capacity (MIC) increased by 12% in one PPS subject but remained unchanged in all others (<6% change). There were no adverse events. Four of the 6 subjects wanted to continue using the technique over the longer term.
CONCLUSIONS: We find a trend toward increased assisted and unassisted PCF, but not MIC, after 3 months of regular home DLI in neuromuscular patients with mild to moderate restrictive impairment. The majority of subjects wished to continue using the technique.
CLINICAL IMPLICATIONS: The feasibility and utility of regular home DLI for improving lung function in this patient population appear favourable and deserve further investigation.
DISCLOSURE: The following authors have nothing to disclose: Marta Kaminska, Franceen Browman, Daria Trojan, Angela Genge, Basil Petrof
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