Ann Rehabil Med.  2023 Apr;47(2):118-128. 10.5535/arm.22103.

Effect of the Inspiratory Method and Timing of Voluntary Cough on Peak Cough Flow

• Kotajima F
• Yatomi M
• Hisada T

• KMID: 2541845
• DOI: http://doi.org/10.5535/arm.22103

Abstract

Objective
To define the effect of the inspiratory method and cough timing on peak cough flow (PCF).
Methods
We investigated the effect of measurement conditions on PCF in healthy subjects (n=10). We then compared obstructive and restrictive pulmonary diseases (n=20) to assess for similar results in respiratory diseases. The PCF was measured under four conditions: before coughing, without maneuver 1 or with maneuver 2 a temporary respiratory pause (4–6 seconds) after rapid inspiration, and without maneuver 3 or with maneuver 4 a temporary respiratory pause after slow inspiration. After the measurements were completed, the PCF between the four conditions was compared for each subject group, and the effect size was calculated.
Results
PCF of maneuvers 1 and 3 were significantly higher than maneuver 4 in healthy subjects (476.34±102.05 L/min and 463.44±107.14 L/min vs. 429.54±116.83 L/min, p<0.01 and p<0.05, respectively) and patients with restrictive pulmonary disease (381.96±145.31 L/min, 354.60±157.36 L/min vs. 296.94±137.49 L/min, p<0.01 and p<0.05, respectively). In obstructive pulmonary disease, maneuver 1 was significantly higher than maneuver 4 (327.42±154.73 L/min vs. 279.48±141.10 L/min, p<0.05). The largest effect sizes were shown by maneuvers 4 and 1.
Conclusion
PCF depends on changes in inspiratory speed before coughing and on temporary respiratory pauses after maximal inspiration. It will become necessary to unify the measurement methods for coughing strength and present appropriate coughing methods.

Keyword

Aspiration pneumonia; Coughing method; Peak cough flow; Peak inspiratory flow; Respiratory rehabilitation

Figure

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  Fig. 1. Peak cough flow (PCF) (A) and peak inspiratory flow (PIF) (B) for each condition in the normal group. PCF differed significantly between M1–M4 and M3–M4, and PIF differed between M1–M3, M1–M4, M2–M3, and M2–M4. The lower and upper margins of the box represent the lower quartile (Q1) and upper quartile (Q3) of the total score, respectively. The band inside the box indicates the median, and the whiskers range from Q1+1.5 interquartile range (IQR) to Q3+1.5 IQR. The horizontal lines above the box graph depict significant differences using Bonferroni correction (*p<0.05, **p<0.01). M, maneuver.

• 

  Fig. 2. Peak cough flow (PCF) (A) and peak inspiratory flow (PIF) (B) for each condition in the obstructive pulmonary disease (OPD) group. PCF differed significantly between M1–M4, and PIF differed between M1–M3, M1–M4, M2–M3, and M2–M4. The lower and upper margins of the box represent the lower quartile (Q1) and upper quartile (Q3) of the total score, respectively. The band inside the box indicates the median, and the whiskers range from Q1+1.5 interquartile range (IQR) to Q3+1.5 IQR. The horizontal lines above the box graph depict significant differences using Bonferroni correction (*p<0.05, **p<0.01). M, maneuver.

• 

  Fig. 3. Peak cough flow (PCF) (A) and peak inspiratory flow (PIF) (B) for each condition in the restrictive pulmonary disease (RPD) group. PCF differed significantly between M1–M4 and M3–M4, and PIF differed between M1–M3, M1– M4, M2–M3, and M2–M4. The lower and upper margins of the box represent the lower quartile (Q1) and upper quartile (Q3) of the total score, respectively. The band inside the box indicates the median, and the whiskers range from Q1+1.5 interquartile range (IQR) to Q3+1.5 IQR. The horizontal lines above the box graph depict significant differences using Bonferroni correction (*p<0.05, **p<0.01). M, maneuver.

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