RT Journal Article SR Electronic T1 How to use a mechanical insufflator–exsufflator “cough assist machine” JF Breathe JO breathe FD European Respiratory Society SP 320 OP 329 VO 4 IS 4 A1 M. Chatwin YR 2008 UL http://breathe.ersjournals.com/content/4/4/320.abstract AB Educational aims 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 [2]. Neuromuscular disease patients may have impaired cough and a reduction in PCF [3] as a result of inspiratory and expiratory muscle weakness, which causes a reduction in the pressure available to drive the cough manoeuvre [4]. While techniques such as breath stacking and manually assisted coughing can improve cough strength, these eventually become ineffective in some adult and paediatric patients.