Self-administered Hyperinsufflation Chest on the Risk of Low Respiratory Infection in Patients With Multiple Sclerosis With Sputum Capacity Deficit (MS-COUGH)

Self-administered Hyperinsufflation Chest on the Risk of Low Respiratory Infection in Patients With Multiple Sclerosis With Sputum Capacity Deficit

Self-administered Hyperinsufflation Chest Mobilization Randomized Study on the Risk of Low Respiratory Infection in Patients With Multiple Sclerosis With Sputum Capacity Deficit

In patients with neuromuscular disease, chest mobilization by hyperinsufflation slows respiratory decline by almost 80% compared to controls, and prevents complications like pneumonia, atelectasis and respiratory distress. This insufflation technique improves the airway clearance and reduces the need for invasive ventilation. It also improves CV and DEPtoux in patients with neuromuscular pathology

During multiple sclerosis (MS), although expiratory involvement and reduced sputum capacity are predominant, automated techniques of hyperinsufflation and in-exsufflation remain underused and undervalued. A single retrospective study suggests a decrease in the decline in respiratory function with regular manual hyperinsufflation. Evidence of a benefit of chest mobilization by hyperinsufflation by a controlled trial is therefore necessary before recommending its use in MS.

Control group: standardized respiratory management. Experimental group: same program, associated with the daily use of a hyperinsufflation technique.

same program as control group associated with the daily use of a hyperinsufflation technique (2 times per day during15 minutes, 5 days a week, for 2 years)

Bronchial decluttering education, respiratory physiotherapy, specialized medical follow-up for 2 years

self-administered mechanical in-exsufflation - CoughAssist (2 x 15 min per day, 5 days per week for 2 years)

Effectiveness of a self-administered automated hyperinsufflation technique for 2 years, versus standard management, on respiratory infection risk within 2 years after randomization, in patients with MS.

This will be evaluated via an online "patient reported outcomes form" and data readings from the internal memory of the COUGH-ASSIST

Inclusion Criteria: Confirmed MS diagnosis (McDonald criteria) EDSS ≥ 7 Age greater than or equal to 18 years. Expiratory flow during a coughing effort (DEPtoux) ˂4.5L / s. Exclusion Criteria: ENT and / or thoracic surgery less than 6 months old Progressive or past pneumothorax / pneumomediastinum Severe swallowing disorders. Inability to use the device under study