Evaluation of the impact of a cough assist mechanical exsufflator device on morbidity, quality of life and survival in patients with MND using non-invasive ventilation (NIV)

Description:

What this research means to you: For people with MND who have respiratory weakness and use non-invasive ventilation (NIV), the inability to cough effectively is a major problem Poor coughing ability causes considerable distress and can lead to serious chest infections. This project aims to establish whether a mechanical “cough-assist” device can reduce infections and improve quality of life and survival for people with MND who are using NIV. If improvements are documented, the study will provide the evidence base to support wider use of cough assist.

The researchers explain in more detail: Non-invasive ventilation (NIV) has been shown to have a positive effect on symptom management, quality of life and survival in people with MND who are experiencing respiratory weakness. However, increasing life expectancy by starting patients on NIV can uncover other downstream problems resulting from weakness of the chest muscles - one major problem is the inability to cough effectively. Poor cough can result in chest infections and blockage of the airways leading to collapse of part of the lung. These problems lead to increasing respiratory failure and often require repeated hospital admissions.

The aim of the present study is to determine whether the use of a mechanical cough assist device can reduce chest infections and hospital admissions and improve the quality of life and survival of patients with MND who need to be started on NIV. Forty MND patients who require NIV will be divided randomly into two groups. One group will have standard care ie NIV without cough assist, and the other group will use the cough assist machine several times per day from the time that NIV is started. Patients will be reviewed every 3 months for 1 year. Outcome measures which will help us to determine whether the cough assist machine is effective include the numbers of days in hospital, chest infections, quality of life measures, measures of respiratory and neuromuscular function, survival of the patient and the impact on the carer. If improvements are documented, this study will provide the evidence base to support wide implementation of this new standard of respiratory care for the benefit of MND patients across the UK.