Directed cough

Coughing is a normal reflex that uses maximum forced expiration to clear irritants or bronchial excretions. A contraction of expiratory muscles suddenly increases intrathoracic pressure and concomitant opening of the glottis generates a very rapid expiratory airflow.

The anatomy of the bronchial tree has important repercussions on ventilatory flows which can be laminar or turbulent depending on the airways and bifurcations. As the bronchial walls are flexible, their diameters vary and the bronchi can collapse. If the viscosity of mucus increases, the flow at which it can be eliminated will be higher.

Directed cough is indicated only for conscious and co-operative patients and consists of coughing efforts with an open glottis (at low pulmonary volume to avoid dynamic compression of the airways) followed by ample ventilation. The physiotherapist can help the patient by applying phased pressure to the thorax and epigastric zone. The recommended rhythm is one session every 2 to 4 h.

This technique may be contraindicated in cases of active tuberculosis, intracranial hypertension, myocardial infarct or unstable angina, and unstable trauma of the spine, and in patients presenting a risk of pulmonary aspiration. This therapy also carries the risk of suture leakage after abdominal surgery.

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