Shaping the Patient’s Therapeutic Cough
The scope of this discussion does not include or address the diagnosis or treatment of “chronic cough” although some of the techniques addressed can be helpful in addressing that specific clinical challenge.
By optimizing the therapeutic cough you can assist the patient in the following:
1) Decreasing the tendency toward uncontrolled, spasmodic ineffective couch.
2) Assist in opening collapsed lung and mobilizing secretions.
3) Decrease the shortness of breath associated with uncontrolled cough.
The framework of primary cough instruction outlined below is divided into, 3 sustained deep breaths with a 3 count breath-holds followed by a set of 3 controlled coughs.
Optimizing those 3 steps will be explored in a later post.
Breaking down clinical instruction into sets of 3, increases the likelihood that our already overwhelmed patients can remember and use techniques effectively. The pattern of, 3 breaths with breath-holds followed by the 3 controlled coughs after the 3rd breath-hold will be utilized as our primary framework of instruction.
Prior to all directed cough maneuvers the patient is instructed in slow deep breathing and breath hold. These slow deep breaths with sustained inspiration are used both in preparation for the maneuvers and between sets of cough instruction. These controlled breaths are directed at re-expanding lung, introducing air behind retained secretions, and helping the patient reduce dyspnea and the tendency toward convulsive cough. All 3 of these effects are more likely accomplished if the deep breaths are accompanied by a breath hold.
Step One – Coach the patient to take their first slow moderately deep breath.
Step Two - Say slowly and out loud for the patient, “hold it, hold it, hold it” in a fashion that results in at least at three second breath hold. (Another set of 3)
Step Three - Encourage the patient to exhale slowly to resting exhalation .
Step One Repeat - The patient is instructed to take second somewhat deeper breath.
Step Two Repeat – And, again coached to, “hold it, hold it, hold it”, encouraging a slightly longer breath hold.
Step Three Repeat - Encourage the patient to exhale slowly to resting exhalation .
Step Three Concluding - For the 3rd and concluding breath the patient is encouraged to inhale to near maximum.
Step Two Concluding- and couched again to, “hold it, hold it, hold it”, while preparing the patient to perform a controlled cough from the near maximal .
