UK survey of current cough augmentation management in patients with motor neurone disease

Background: Individuals with motor neurone disease (MND) develop an ineffective cough due to respiratory muscle weakness. Cough augmentation guidance for MND patients is limited and current UK practice is unknown. Aim: To establish current UK practice in cough augmentation management for patients with MND and understand clinician perceived barriers and facilitators to practice. Method: A cross-sectional online survey gathered information on practice patterns of services providing cough augmentation management for individuals with MND. Results: A total of 41 services were analysed. Participants indicated discussions about cough augmentation should occur at or slightly after diagnosis of MND. Screening commonly utilises signs and symptoms and peak cough flow. Participants indicated that referrals should be early, before the onset of significant signs and symptoms. The three most common strategies used are mechanical insufflation-exsufflation, lung volume recruitment and unaided breath stacking. Timing of initiation of strategies remains unclear. Barriers to clinical practice include lack of skills and awareness of strategies’ benefits, patient’s tolerance of the strategy and funding. Conclusion: Current UK practice for cough augmentation management in MND is varied. Information regarding signs and symptoms has been summarised to guide screening and referral pathways as well as how to monitor and optimise strategies. Further research is warranted for screening, referrals, initiation, strategy prescription, follow up and cost versus benefit. An educational program focussing on when discussions should occur, screening, strategies and service pathways is recommended.