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Huffing / bumping

Tell the patient that the purpose of hopping / shocking is to facilitate breathing by removing secretions. Huffing / impact means a forced, strong exhalation after a slightly deeper inhalation. During such an exhalation, a dynamic compression of the trachea occurs. The air flow becomes faster and stronger, which means that secretions are released and taken higher up in the airways where it can be removed more easily [17].

Huffing / shock is a complement to coughing, but is less painful after, for example, an operation on the abdomen. It reduces the risk of bronchospasm for those who have sensitive airways, such as asthma or COPD. The method is also gentler on the pelvic floor muscles compared to coughing [17].

Huffing / pushing can be easier to perform if the patient himself, or someone else, helps to support the abdominal muscles and / or chest during the performance. Huffing is difficult for some patients. Therefore, practice the technique together a couple of times. An instruction such as “do as you do when fogging on a mirror” can help you find the right technique. Contact a physiotherapist for help [17,18].

Host machine

Secretion mobilization using a coughing machine has become an increasingly common way to help the patient to cough up mucus and make it come loose [13,14]. A cough machine is a mechanical in- and exsufflator that tries to mimic a cough shock and is used primarily for neurologically weak or neurologically injured patients who have a bad cough shock but can also be used in other conditions. For treatment to work, some parameters are required:

A lot of secret.

Weak cough shock, measured as PCF (peak cough flow) using a PEF meter.
There must be some tone in the throat and upper respiratory tract.
Relatively healthy lungs [13,14].

The treatment must be prescribed by a doctor and tested by a physiotherapist.

Equipment cleaning:

For cleaning, see the manufacturer’s instructions.
Hose and adapter should be disposable material and changed once a day and if necessary.

Impulse spirometer

There are training tools that provide visual feedback for inhalation training. Both inhalation flow and volume can be trained. The equipment is intended for single patient use. Instruction of breathing technique is required where the focus is on a controlled slow inhalation in order to maintain the pressure for a while at the end. The equipment is called a breathing trainer or Impulse spirometer [11].


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