Assisted Coughing

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In conditions such as spinal cord injury or neuromuscular disease an individual may require assistance to cough using manual techniques or a medical device. Manual assisted cough is the compression of the diaphragm by another person to replace the work of abdominal muscles in order to facilitate a cough. A medical device can be used to assist coughing effort by a positive pressure breath followed by a rapid change to negative pressure.[1]


Prevention and treatment of sputum retention

Clinical presentation

  • Subjectively 'chesty'
  • Aubible secretions at the mouth
  • Crackles heard on auscultation
  • Tactile fremitus
  • Hypoxemia


Manual assisted cough Cough assist device
Direct pressure should be avoided to rib fractures or surgical sites. Undrained pneumothorax

Frank haemoptysis


Facial fractures

CVS instability

Raised intracranial pressure (ICP)

Recent upper GI surgery

Lung abscess



Manual assisted cough Cough assist device
Immediately following surgery

Paralytic ileus

Rib fractures

Raised ICP

Undrained pneumothorax



Unstable spine

Oxygen dependency



Patient complience

Airway obstruction


Cough assist device troubleshooting

Please also see non-invasive ventilation for more information on positive pressure devices



  1. 1.0 1.1 1.2 Harden, B. (2004). Emergency physiotherapy: An on-call survival guide. 1st ed. Edinburgh: Churchill Livingstone.