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Cough
Assessment
and
Augmentation
咳嗽能力之評
估及促進技術
赴碧燕
The 2nd Critical Rehabilitation and
香港物理治療師
Cardiopulmonary Rehabilitation Seminar
23 SEPTEMBER 2017
Cough Augmentation
4 Phases of cough
Diaphragm Glottic Closure Anterior/lateral
Muscles Intercostals Lateral crioarytenoids abdominals
Accessories transverse arytenoid Accessories
Cough efficacy in healthy individual
7th to 12th generation
Cough reflex
Normal cough
Inspiratory
volume of
around
2.3L but
50% of
vital
capacity
Normal cough
Glottic closure
for 0.2 second
Normal cough
Contraction
of the
expiratory
muscles
intact
expiratory
muscle
MEP
60cmH2O
producing a
audible noise
Normal cough
Inspiration
▪ 60-90% Total Lung Capacity
Contraction phase
▪ patients glottis closes and the expiratory muscles begin to contract.
This phase lasts only 0.2 seconds; however, during this time, elevated
intrathoracic pressures are reached
Expulsion Phase
▪ Glottis opens, shearing force created. During this expiratory phase flow
rates of 360 to 1000 L/minute are generated in a normal cough
Cough assessment
▪Airflow Waveforms
▪Flow Volume Loops (Cough spikes)
▪Spirometry
▪Maximal Insufflation Capacity
▪Peak Cough Flow
▪Respiratory Muscle Testing
Measurement of PCF
▪The peak flow meter is connected
to the face mask
▪The patient is asked to take a deep
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