• Louise Rose, Douglas McKim, David Leasa, Mika Nonoyama, Anu Tandon, Marta Kaminska, Colleen O'Connell, Andrea Loewen, Bronwen Connolly, Patrick Murphy, Nicholas Hart, and Jeremy Road.
• Department of Critical Care, Sunnybrook Health Sciences Centre & Sunnybrook Research Institute, Toronto, Canada; the Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, UK; the Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Canada. louise.rose@utoronto.ca.
• Respir Care. 2018 Dec 1; 63 (12): 1506-1513.

BackgroundRegular monitoring combined with early and appropriate use of airway clearance can reduce unplanned hospital admissions for patients with neuromuscular disease (NMD) and spinal cord injury (SCI). We aimed to describe and compare knowledge of guidelines, monitoring of cough effectiveness, clinician prescription/provision of airway clearance strategies, and service provision constraints in the United Kingdom and Canada.MethodsThis was a cross-sectional survey of clinicians affiliated with NMD and SCI clinics in Canada, 2016 attendees at the Home Mechanical Ventilation Conference in the United Kingdom, and United Kingdom physiotherapist networks.ResultsWe received 155 surveys (92 from Canada; 63 from the United Kingdom). More UK respondents (76%) were aware of airway clearance guidelines than Canadian (56%) respondents (P = .02). Routine assessment of cough effectiveness was reported by more UK respondents (59%) than Canadian (42%) respondents (P = .044). Cough peak flow (CPF) was the most common method used in both countries, although it was more commonly used in the UK (96%) than in Canada (81%, P = .02). Fewer Canadian respondents reported using CPF before initiation of airway clearance (81% vs 94%, P = .046), and fewer Canadian respondents showed results to patients for technique feedback (76% vs 97%, P = .007). Similar participant numbers reported using CPF after initiation to ensure adequate technique (73% vs 72%, P = .92). Mechanical insufflation-exsufflation (MI-E) + lung volume recruitment (LVR) + manually assisted cough when CPF ≤ 270 L/min was most routinely recommended (41% overall). Monotherapy was infrequent (LVR 15%, manually assisted cough 7%, and MI-E 4%). More Canadians identified constraints on service provision, specifically insufficient public funding for equipment (68% vs 39%, P = .002) and inadequate community workers' knowledge (56% vs 34%, P = .002). Funding for community support was a common constraint in both countries (49% vs 42%).ConclusionsThe somewhat variable cough effectiveness monitoring and airway clearance practices identified in this survey confirm the need for further work on knowledge translation related to guideline recommendations and the need to address common constraints to optimal service delivery.Copyright © 2018 by Daedalus Enterprises.

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