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Induced cough

Hello, I am the mother of a French child of 20 months followed in France. We live in Morocco. My daughter has daily physiotherapy sessions. The respiratory therapist trained in France induces the cough reflex at least 10 to 15 times per session. Can this cause a fragility, an abnormal growth of the larynx or this anatomic area in the long term, if the gesture is repeated too much, too abrupt or poorly executed?
thank you in advance
Dear Madam,

We cannot answer in a simple way to your question.
We know that cough is a natural reflex triggered by the presence of a foreign body in the trachea or large bronchi (sensors of irritation). Cough may be induced by manually pressing the trachea. This technique has been used in some European countries (e.g. France) for many years, however is not a technique which is recommended in international physiotherapy guidelines due to lack of evidence on its benefit. It will cough up secretions already in the larynx or bronchi. Gesture of “induced cough” (manual pressure on the trachea) should be abandoned as soon as the child is able to cough on demand (around 2-2.5 y.o.). It is also known that the coughing reflex is exhausted more or less quickly over the session.
There is no publication reporting the effects of “induced cough” gesture on larynx growth. However it has been used in France for over 20 years with no reported side effects. It does need to be used by a trained operator and is mainly performed by therapists rather than parents.
However, as a precaution, it is recommended to restraint in this gesture and therefore, trigger the cough only in the following conditions :
- in small children that cannot achieve coughing on demand
- when secretions have moved to the area where the cough is effective.
An alternative to the manual pressure on trachea is holding the child in the prone position in the physiotherapist’s arms. He moves the child's head backward, such extension may cause a cough without pressing on the trachea.
We do need to remember that a cough is the best way to do airway clearance, it can be incorporated into all techniques. Frequent coughing in babies and very young children can make a predisposition to collapsing tracheal walls more likely. It has been shown that coughing causes the most instances of gastroesophageal reflux in a population of babies already predisposed to a higher level than non CF babies and so can compromise their airways.
We invite you to contact your CF Centre, or suggest that the physiotherapist who supports your little daughter get in touch with her counterpart of the French CF Centre.
Hoping to have provided you with some answers.

Best regards

Claudine Lejosne

11.4.11 In general there is no evidence that one Airway clearance technique is superior to another. The international CF physiotherapy group have published an information booklet (formerly the blue booklet) and it is available to download from the World Wide CF website. There are also many information leaflets(factsheets) available from the CF Trust website and written by the Asoociation Chartered Physiotherapists Cystic Fibrosis group that explain each technique and it’s application.

D. d'Alquen