NHS Cough Assist User manual

PROUD TO MAKE A DIFFERENCE
SHEFFIELD TEACHING HOSPITALS NHS FOUNDATION TRUST
Cough assist
Information for patients, families and
carers
Therapy Services

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Table of contents
Why do I need a Cough Assist?
What is a Cough Assist?
My E70 Cough Assist
Set up and use
Circuit
Interface
Treatment
My E70 Cough Assist prescription
Settings
Action plan
Cleaning and maintenance
Frequently asked questions (FAQs)
References
Contact numbers
Contact details
Replacement equipment
5
5
6
7
8
8
9
10
11
12
13
14
14
15
15
15
** Please make sure you bring this booklet and your Cough Assist machine
to all of your respiratory physiotherapy appointments and
any admission to hospital **

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What is a Cough Assist?
A Cough Assist is a machine that helps to clear phlegm from the lungs. The machine delivers a big
breath in (deep breath), then quickly changes to a big breath out (cough breath) to remove phlegm
from the lungs.
The type of Cough Assist machine we use is called an E70.
Why do I need a Cough Assist?
Coughing is an essential part of life. The linings of the airways naturally produce phlegm on a daily
basis to trap any dirt and bacteria that may enter your airways. If this phlegm is not removed it could
collect in the airways and cause chest infections and damage to the airways. The body’s natural way
of getting rid of phlegm from the airways is by coughing.
There are three steps to a cough:
1. Deep breath in
2. Build up of pressure in the lungs
3. Squeezing of your muscles to create a 'cough'
The muscles in your chest and stomach are needed to produce a strong cough. If your muscles are
weak your cough may not be strong enough to clear phlegm from your lungs. It is very important to
have an effective way of clearing phlegm and a Cough Assist can help to do this.

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My E70 Cough Assist
1.
2.
3.
4.
5.
Power button: Turns the machine on
and off
Circuit connector: Connect your Cough
Assist circuit here
Main screen: Where you navigate the
menus and view the settings on the Cough
Assist
Navigational buttons: Allow you to start
and end treatment as well as change
settings
The Manual switch: Your physiotherapist
will advise you if you need to use this
6.
7.
8.
9.
AC Power input: Connect the mains
power here
Air inlet & pollen filter: This allows air to
enter the machine; this is where you will
insert the pollen filter supplied with your
Cough Assist.
* Do not cover when using *
Air Outlets: This is where the air leaves
the inside of the machine.
* Do not cover when using *
Battery: Detachable battery slot. Your
physiotherapist will advise you if you need a
battery
3
4
5
2
1
8
6
7
9

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Set up and use
Plug the machine into the mains power using the power cord supplied. Set up and connect your
circuit to the circuit connector on the side of the machine (See below for full set up guide).
1. Turn the machine ON using the power button.
2. Press Therapy using the right navigational button. This will begin your treatment.
3. Once you have finished the treatment press Standby using the right navigational button. This
will stop treatment.
If you use more than one pre-set
1. Turn the machine ON using the power button.
2. Press the left navigational button to
enter Settings.
3. Press Modify using the right
navigational button.
4. Use the up and down navigational
buttons to select the appropriate pre-set
(as prescribed by your physiotherapist).
5. Press OK using the right navigational
button.
6. Press Finish using the left navigational
button.
7. Once back at the main screen press Therapy using the right navigational button.
This will begin your treatment.
8. Once you have finished the treatment press Standby using the right navigational button. This
will stop treatment.
4
2
1
3, 5
67, 8

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Circuit
The Cough Assist circuit and interface need to be set up and used correctly to make sure the machine
works effectively. Your physiotherapist will teach you (and your family or carers) how to set up and
use the Cough Assist. The picture below shows you how to put the circuit together.
Interface
The interface is the attachment at the end of the circuit used to deliver the Cough Assist treatment.
Having the correct interface is important to make sure you can cough and clear any phlegm from your
chest.
The interface is carefully selected by your Physiotherapist according to which one best suits your
needs. Below are the three options of interface. You will usually only have one of these.
(Physiotherapist: Please tick chosen option)
Mask
A well-fitting, soft-seal mask is important to reduce
possible leak.
This will need to be held firmly in place during
treatment either by you, or a family member or carer.
Mouth Piece
When using a mouthpiece, It is important to make a
tight seal with your lips. A nose clip may also be
required to prevent air leaking out of your nose.
Tracheostomy Mount
The mount attaches the circuit to the end of your
tracheostomy.
Interface
Adaptor
Tubing
Device

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Treatment
The treatment using the E70 Cough Assist will be personal to you. The treatment session that is best
for you will be prescribed by your physiotherapist.
The E70 Cough Assist machine has three different settings. These settings will give you deep breaths;
cough breaths or a mixture of both.
Deep breaths
This setting gives you big breaths in.
Cough breaths
This setting gives you a big breath in followed straight
away by a big breath out (cough breath).
Deep breaths and cough breaths
This setting gives you several big breaths in followed by
a cough breath.
- +
Settings
- +
Settings
- +
Settings

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My E70 Cough Assist prescription
Your Cough Assist will be set up by your physiotherapist with the settings that are best for you. The
settings on your cough assist will be saved as a 'preset'. You should try and follow the prescription
below.
During a treatment, you should try and sit as upright as possible with your head up. If you are unable
to carry out your treatment on your own you may want to agree on a signal with your relative/carer to
alert them that you want to stop treatment.
Repeat your prescription ............... times.
If you are unwell or have increased symptoms follow the advice below and refer to the
advice on page 11.
Preset number Deep breaths Cough breaths

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Settings
For attention of your health care professional (please note that device settings may be out of date)
Preset:
Mode: Manual / Auto
/ Advanced auto
pre-therapy / Advanced
auto therapy
Interface: Mouthpiece
/ Facemask / Trachy /
ETT
Cough-Trak: On / Off
Inhale flow:
Low / Medium / High
Inhale pressure:
Inhale time:
Exhale pressure:
Exhale time:
Pause time:
Advanced Auto
Pre-therapy: Off /
Number of breaths .....
Advanced Auto
Therapy breaths:
Number of breaths .....
Advanced Auto
Post-therapy: On / Off
Advanced Auto
Cycles: .....
Preset:
Mode: Manual / Auto
/ Advanced auto
pre-therapy / Advanced
auto therapy
Interface: Mouthpiece
/ Facemask / Trachy /
ETT
Cough-Trak: On / Off
Inhale flow:
Low / Medium / High
Inhale pressure:
Inhale time:
Exhale pressure:
Exhale time:
Pause time:
Advanced Auto
Pre-therapy: Off /
Number of breaths ......
Advanced Auto
Therapy breaths:
Number of breaths .....
Advanced Auto
Post-therapy: On / Off
Advanced Auto
Cycles: .....
Preset:
Mode: Manual / Auto
/ Advanced auto
pre-therapy / Advanced
auto therapy
Interface: Mouthpiece
/ Facemask / Trachy /
ETT
Cough-Trak: On / Off
Inhale flow:
Low / Medium / High
Inhale pressure:
Inhale time:
Exhale pressure:
Exhale time:
Pause time:
Advanced Auto
Pre-therapy: Off /
Number of breaths ......
Advanced Auto
Therapy breaths:
Number of breaths .....
Advanced Auto
Post-therapy: On / Off
Advanced Auto
Cycles: .....
Preset:
Mode: Manual / Auto
/ Advanced auto
pre-therapy / Advanced
auto therapy
Interface: Mouthpiece
/ Facemask / Trachy
/ ETT
Cough-Trak: On / Off
Inhale flow:
Low / Medium / High
Inhale pressure:
Inhale time:
Exhale pressure:
Exhale time:
Pause time:
Advanced Auto
Pre-therapy: Off /
Number of breaths ......
Advanced Auto
Therapy breaths:
Number of breaths .....
Advanced Auto
Post-therapy: On / Off
Advanced Auto
Cycles: .....

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Action plan
Adapted from 'Physiotherapy management of the adult, medical, spontaneously breathing patient. Web Appendix 10 –
Action Plan for a Person with Neuromuscular disease' BTS Guidelines (2009)
If the following describes you Action required
Green
If you have an
effective cough
and no signs of a
chest infection
- You are able to work, play or
function as usual
- You do not have any of the
symptoms in the next section
• Continue your prescriped
cough assist routine
Amber:
If your symptoms
are troublesome
and getting worse
- You start to feel unwell with cold
or cough or notice a change in
your cough
- You are producing phlegm which
is difcult to clear
- You notice any of the following:
• You are having difculty
swallowing
• You are more breathless on
activity or lying at
• You are waking with
headaches in the morning
• You feel tired during the day
• You are lacking concentration
• You suffer from general
malaise or poor appetite
• You are getting regular chest
infections
• You are needing to use your
ventilator more than normal
• Contact GP/ventilation service
for a review or advice
• Consider starting your home
supply of antibiotics (if you have
them) if sputum green or yellow
• Increase use of cough assist as
advised by your Physiotherapist
Red:
Your symptoms
have not
improved or
continue to
worsen
- You are unwell with cold or
cough and this has not improved
with antibiotics /or treatment
prescribed above
- You are producing phlegm and
you are unable to clear it
- You are very breathless
• Contact your GP or local
ventilatory service for an
emergency assessment and
advice.
• If you are on ventilation you can
use your ventilator to support
you while you wait for advice
and or assessment
• If you have an oxygen alert card
make sure you give this the
health professional looking after
you
• Do not delay – get help now

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Cleaning
Machine
Unplug the machine and clean the outside using a damp cloth using warm water and washing up
liquid.
Allow the machine to dry completely before plugging in the power cord.
The machine requires servicing every two years. You will be contacted when this is due.
Circuit
The circuit and patient interface should be washed thoroughly with warm water and washing up
liquid. We recommend this is done weekly but it may be required more often if you are coughing up
a lot of phlegm. These parts must completely air dry before reuse.
The mask will need to be replaced if it becomes torn or if you can no longer maintain a good seal.
Pollen Filter
This should be taken out of the back of the machine once a week and washed in warm water and
washing up liquid. This should be completely dried before replacing.
If you need a replacement please contact the Pulmonary Function Unit
- see page 14 for contact information.

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Frequently asked questions (FAQs)
Question: Will I be taught how to use the machine before being given it at home to use?
Answer: Yes. Your physiotherapist will show you your E70 Cough Assist and explain how to use it.
They will check that you are able to use it correctly. They will also make sure that your family or carers
are able to use the machine. If you have any questions about using the machine you should contact
the Respiratory Physiotherapy Department on [phone] (Monday - Friday, 8.30am - 4.30pm).
Question: Who do I contact if I have questions about the use of the machine?
Answer: If you have a question about how to use the E70 Cough Assist or are having problems using
your Cough Assist you should contact the Respiratory Physiotherapy Department on [phone]
(Monday - Friday, 8.30am - 4.30pm).
Question: Who do I contact if there is a fault with the machine?
Answer: If you have a problem with the E70 Cough Assist machine, or you think that you need a
new circuit you should contact the Pulmonary Function Unit on [phone] (Monday - Friday,
8.30am - 4.30pm).
Question: Who will be responsible for machine maintenance?
Answer: Your E70 Cough Assist machine remains the property of Sheffield Teaching Hospitals NHS
Foundation Trust. This means we take responsibility for all repair and on-going servicing. Your
machine will require servicing every two years. You will be contacted when it is due.
Question: What do I do if my E70 Cough Assist is not working outside of normal working
hours?
Answer: If your E70 Cough Assist needs replacing urgently and you cannot wait until the next
working day please contact Robert Hadfield 5 ward on 0114 266 9575 and ask to speak to the
nurse in charge. In order to get a replacement E70 Cough Assist you, or someone else on your
behalf, will need to attend the ward with your E70 Cough Assist and this booklet.
References:
• BTS/ACPRC (2009) Guidelines for physiotherapy management of the adult, medical
spontaneously breathing patient. Thorax, 64(1), i1-51. Web Appendix 10.

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Contact numbers:
Respiratory Physiotherapy Department:
• 0114 271 5060
Monday - Friday, 8.30am - 4.30pm
Pulmonary Function Unit:
• 0114 226 9605
Monday - Friday, 8.30am - 4.30pm
Useful contact details
My Neurology Consultant is .......................................................................................................
My Respiratory Consultant is ......................................................................................................
My Respiratory Physiotherapist is .............................................................................................…
I need replacement equipment, what should I do?
If you are worried that any of your NIV equipment is damaged or broken, you should contact the
Pulmonary Function Unit (PFU) at the Northern General Hospital:
•0114 226 9605
Monday - Thursday: 7.30am - 6.00pm
Friday: 8.00am - 4.00pm
If you have problems outside these hours during the week or at a weekend and you need
replacement equipment urgently you should contact Robert Hadfield 5 ward at the Northern
General Hospital on:
•0114 271 5092

PD9659-PIL4111 v2 Issue Date: July 2022. Review Date: July 2025
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