To raise awareness of how to use mechanical insufflator–exsufflators.
To discuss the use of mechanical insufflation–exsufflation compared with conventional airway clearance techniques.
To identify an escalation treatment protocol.
Summary Effective cough is a protective mechanism against respiratory tract infections. In patients with respiratory muscle weakness due to neuromuscular disease, respiratory tract infections are the commonest cause of hospital admission . Neuromuscular disease patients may have impaired cough and a reduction in PCF  as a result of inspiratory and expiratory muscle weakness, which causes a reduction in the pressure available to drive the cough manoeuvre . While techniques such as breath stacking and manually assisted coughing can improve cough strength, these eventually become ineffective in some adult and paediatric patients.
- ©ERS 2008