How Physiotherapist helps in COUGHING?

What is the Role of a physiotherapist in Coughing? An effective cough is necessary to eliminate respiratory obstructions and keep the lungs clear. Coughing is one of the most common Lung Airway clearance technique which is performed by a person acting with minor instruction by therapist or instructors. Airway clearance is an important part of the management of patients with acute or chronic respiratory conditions.

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A cough may be reflexive or voluntary. When a person coughs, a series of actions occur, we call it as An effective cough is necessary to eliminate respiratory obstructions and keep the lungs clear. Coughing is one of the most common Lung Airway clearance technique which is performed by a person acting with minor instruction by therapist or instructors. Airway clearance is an important part of the management of patients with acute or chronic respiratory conditions., it includes:

1. The patient inhales air by the nose (Deep inspiration occurs )
2. Air traps inside the lungs (Glottis closes, and vocal cords tighten)
3. Increase in intrathoracic and intra-abdominal pressures due to the closer of the epiglottis and air entrapment inside the cavity.
4. The patient opens glottis voluntary (Opening of Glottis)
5. Explosive expiration of air (coughing)

Teaching an Effective Cough

                                 Because an effective cough is an integral component of airway clearance, a patient must be taught the importance of an effective cough, how to produce an efficient and controlled voluntary cough, and when to cough. The following sequence and procedures are used when teaching an effective cough.

1. Assess the patient’s voluntary or reflexive cough.

2. Have the patient assume a relaxed, comfortable position for deep breathing and coughing. Sitting or leaning forward usually is the best position for coughing. The patient’s neck should be slightly flexed to make coughing more comfortable.

3. Teach the patient-controlled diaphragmatic breathing, emphasizing deep inspirations.

4. Demonstrate a sharp, deep, double cough.

5. Demonstrate the proper muscle action of coughing (a contraction of the abdominals). Have the patient place the hands on the abdomen and make three huffs with expiration to feel the contraction of the abdominals Have the patient practice making a “K” sound to experience tightening the vocal cords, closing the glottis, and contracting the abdominals.

6. When the patient has put these actions together, instruct the patient to take a deep but relaxed inspiration, followed by a sharp double cough. The second cough during a single expiration is usually more productive.

7. Use an abdominal binder or glossopharyngeal breathing in selected patients with inspiratory or abdominal muscle weakness to enhance the cough, if necessary.

Precautions for Teaching an Effective Cough

  •  Never allow a patient to gasp in air, because this increases the work(energy expenditure) of breathing, causing the patient to fatigue more easily. It also increases turbulence and resistance in the airways, possibly leading to increased bronchospasm and further constriction of airways. A gasping action also may push mucus or a foreign object deep into air passages.
  •  Avoid uncontrolled coughing spasms (paroxysmalcoughing).
  • Avoid forceful coughing if a patient has a history of a cerebrovascular accident (stroke) or an aneurysm. Have these patients huff several times to clear the airways, rather than a cough.
  •  Be sure that the patient coughs while in a somewhat erect or side-lying posture.



                     This is brief information about how your Physiotherapist generally performs coughing, I strongly recommend you to visit your family physician and/or Physiotherapist for detailed assessment and further treatment. Do not Perform any treatment at home without proper instruction.

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