3. Study results grouped by outcome measures and interventions – comparison of individual and combination cough augmentation therapies with alternative individual and combination interventions.
| Outcome measure | Unassisted cough | MI | MI‐E | MAC | Manual BS | MAC + MI | MAC + manual BS | MAC + MI‐E | Between‐group differences |
| PCF (L/min) |
Sivasothy 2001 (n = 4) Median (range) |
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| 288 (175 to 367)a | 231 (148–597) | — | 193 (185–287) | — | 362 (218–440) | — | — | NS | |
|
Brito 2009 (n = 28) Mean ± SD | |||||||||
| 171 ± 67a | — | — | 231 ± 81 | 225 ± 80 | — | 292 ± 86 | — | Manual BS vs unassisted cough: P < 0.001 Manual BS vs MAC: NS MAC + BS vs unassisted cough: P < 0.001 MAC vs MAC + BS: P < 0.05 Manual BS vs MAC + BS: P < 0.05 |
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|
Lacombe 2014 (n = 18) Mean ± SD | |||||||||
| — | — | Absolute valueb: 210.6 ± 52.8 MD from baselineb: 53.4 ± 51.0; n = 7 |
— | — | Absolute valueb: 225 ± 83.4 MD from baselineb: 124.8 ± 38.4; n = 4 |
— | Absolute valueb: 210.6 ± 50.4 MD from baselineb: 106.2 ± 50.4; n = 7 |
Comparison of MDs (intervention – baseline): MI + MAC vs MI‐E alone: MD 71.4, 95% CI 18.08 to 124.72); P = 0.009 MI‐E + MAC vs MI‐E alone: MD 52.8, 95% CI –0.32 to 105.92; P = 0.05 MI‐E + MAC vs MI + MAC: MD –18.6, 95% CI –71.61 to 34.41; P = 0.49 |
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|
Kim 2016 (n = 40) Mean ± SD | |||||||||
| 95.7 ± 40.5 | — | 177.2 ± 33.9 | — | — | — | 155.9 ± 53.1 | 202.4 ± 46.6 | MAC + manual BS vs unassisted cough: P < 0.01 MI‐E vs unassisted cough: P < 0.01 MI‐E vs MAC + manual BS: P < 0.01 MI‐E + MAC vs unassisted cough: P < 0.01 MI‐E + MAC vs MAC + manual BS: P < 0.01 MI‐E + MAC vs MI‐E alone: P < 0.01 |
|
| Transcutaneous oxygen saturation (%) |
Chatwin 2009 (n = 8) Mean |
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| — | — | — | Data not reported | — | — | — | Data not reported | NS difference in group means | |
| Transcutaneous carbon dioxide tension (%) |
Chatwin 2009 (n = 8) Mean |
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| — | — | — | Data not reported | — | — | — | Data not reported | NS difference in group means | |
| Maximum inspiratory or insufflation capacity (L) |
Lacombe 2014 (n = 18) mean ± SD |
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| — | — | 1.55 ± 0.34b; n = 7 | — | — | 1.43 ± 0.34b; n = 4 | — | 1.39 ± 0.43b; n = 7 | Comparison of means: MI‐E vs MI + MAC: MD –0.12, 95% CI –33.44 to 33.20; P = 0.99 MI‐E vs MI‐E + MAC: MD –0.16, 95% CI –0.57 to 0.25; P = 0.44 MI+ MAC vs MI‐E + MAC: MD 0.04, 95% CI –0.42 to 0.50; P = 0.86 |
|
| Cough expiratory volume (L) |
Sivasothy 2001 (n = 4) Median (range) |
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| 0.9 (0.5–1.1)a | 0.7 (0.3–1.3) | — | 0.5 (0.41–1.01) | — | 0.6 (0.4–1.01) | — | — | NS | |
| Heart rate (beats per minute) |
Chatwin 2009 (n = 8) Not specified |
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| — | — | — | Data not reported | — | — | — | Data not reported | NS | |
| Effective cough time (ms) |
Lacombe 2014 (n = 18) Mean ± SD |
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| — | — | Absolute valueb: 70 ± 79 MD from baselineb: 54 ± 95; n = 7 |
— | — | Absolute valueb: 93 ± 111 MD from baselineb: 93 ± 111; n = 4 |
— | Absolute valueb: 22 ± 47 MD from baselineb: 20 ± 42; n = 7 |
MI‐E vs MI + MAC: MD 39.0, 95% CI –90.56 to 168.56; P = 0.56 MI‐E vs MI‐E + MAC: MD –34.00, 95% CI –110.95 to 42.95; P = 0.39 MI + MAC vs MI‐E + MAC: MD 73.00, 95% CI –40.14 to 186.14; P = 0.21 |
|
| Peak value time (ms) |
Sivasothy 2001 (n = 4) Median (range) |
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| 44 (40–50)a | 45 (30–60) | — | 50 (35–55) | — | 50 (45–120) | — | — | NS | |
| Treatment time after 30 minutes (min) |
Chatwin 2009 (n = 8) Median (range) |
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| — | — | — | 17 (0–35) | — | — | — | 0 (0–26) | P = 0.03 | |
| Auscultation score (VAS 10‐point score) |
Chatwin 2009 (n = 8) MD ± SD before to after intervention |
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| — | — | — | 3.4 ± 2.0 to 2.3 ± 2.2; P = 0.007 | — | — | — | 2.9 ± 1.9 to 1.8 ± 2.0; P = 0.02 | Significance level not reported | |
| Secretions (VAS 10‐point score) |
Chatwin 2009 (n = 8) MD ± SD before to after intervention |
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| — | — | — | 4.4 ± 2.5 to 3.0 ± 1.4; P = 0.03 | — | — | — | 4.0 ± 2.2 to 1.7 ± 0.4; P = 0.03 | Significance level not reported | |
| Comfort (VAS 10‐point score) |
Chatwin 2009 (n = 8) Baseline to after intervention |
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| — | — | — | Data not reported (NS) |
— | — | — | Data not reported (NS) | Data presented graphically only. Significance level not reported |
|
|
Lacombe 2014 (n = 18) Median (IQR) | |||||||||
| — | — | Original report: 6.4 (5.5 to –7.0) b5.7 (0.9) |
— | — | Original report: 7.0 (6.0–8.5) b5.9 (1.15) |
— | Original report: 6.6 (5.8–8.0) b6.8 (.7) |
NS | |
| Subjective cough effectiveness (VAS 10‐point score) |
Sivasothy 2001 (n = 4) Not reported |
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| Not reported* | Not reported | — | Not reported | — | Not reported | — | — | Participants did not report benefit of any intervention. | |
|
Lacombe 2014 (n = 18) Median (IQR) | |||||||||
| — | — | Original report: 6.4 (4.8–8.2) b7.2 (2.4) |
— | — | Original report: 8.3 (7.2–9.0) b7.1 (0.8) |
— | Original report: 8.5 (6.2–9.0) b8.0 (1.95) |
Original report: MI‐E + MAC vs MI‐E: P < 0.05 MAC + MI vs MI‐E: P < 0.05 |
|
| Breathlessness (VAS 10‐point score) |
Chatwin 2009 (n = 8) Baseline to after intervention score |
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| — | — | — | Data not reported (NS) |
— | — | — | Data not reported (NS) |
Data presented graphically only. Significance level not reported |
|
| Mood (VAS 10‐point score) |
Chatwin 2009 (n = 8) Baseline to after intervention score |
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| — | — | — | Data not reported (NS) |
— | — | — | Data not reported (NS) |
Data presented graphically only. Significance level not reported |
|
| Fatigue (VAS 10‐point score) |
Chatwin 2009 (n = 8) MD ± SD before to after intervention |
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| — | — | — | Data not reported (NS) | — | — | — | 3.2 ± 2.2 to 5.1 ± 2.6 (P = 0.005) |
Incomplete reporting. Significance level not reported |
|
BS: breathstacking; CI: confidence interval; GPB: glossopharyngeal breathing; IQR: interquartile range; PCF: peak cough flow; MAC: manually assisted cough; MD: mean difference; ME: mechanical exsufflation; MI: mechanical insufflation; MI‐E: mechanical insufflation/exsufflation; min: minute; n: number of participants; NS: not significant; SD: standard deviation; VAS: visual analogue scale.
aBaseline value – not a randomly assigned control.
bUsing raw first‐period data provided by the author on request.