{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T12:21:04Z","timestamp":1790079664924,"version":"4.0.1"},"reference-count":106,"publisher":"SAGE Publications","issue":"7","license":[{"start":{"date-parts":[[2021,2,12]],"date-time":"2021-02-12T00:00:00Z","timestamp":1613088000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Respir Care"],"published-print":{"date-parts":[[2021,7]]},"abstract":"<jats:p>When the ability to cough is impaired, secretion clearance may be assisted and augmented with mechanical insufflation-exsufflation (MI-E). In some individuals, the efficacy of MI-E may be hampered by counterproductive upper airway reactions, where the airways close in response to positive pressures. To fully utilize the therapeutic potential inherent in the MI-E technology, we need a better understanding of the pathophysiology behind these untoward reactions. There is increasing interest in monitoring and measuring upper airway responses to MI-E and how such information can be used to optimize MI-E settings. The purpose of this narrative review is to increase the theoretical understanding of the larynx as a respiratory organ, summarize the current literature in the area, and provide insight into how this knowledge can affect current clinical practice.<\/jats:p>","DOI":"10.4187\/respcare.08960","type":"journal-article","created":{"date-parts":[[2021,2,12]],"date-time":"2021-02-12T13:50:46Z","timestamp":1613137846000},"page":"1196-1213","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":42,"title":["Upper Airway Assessment and Responses During Mechanically Assisted Cough"],"prefix":"10.1177","volume":"66","author":[{"given":"Tiina M","family":"Andersen","sequence":"first","affiliation":[{"name":"Thoracic Department, Norwegian Advisory Unit on Home Mechanical Ventilation, Haukeland University Hospital, Bergen, Norway."},{"name":"Department of Physiotherapy, Haukeland University Hospital, Bergen, Norway."},{"name":"The Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brit","family":"Hov","sequence":"additional","affiliation":[{"name":"Thoracic Department, Norwegian Advisory Unit on Home Mechanical Ventilation, Haukeland University Hospital, Bergen, Norway."},{"name":"Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway."},{"name":"Institute of Clinical Medicine, University of Oslo, Oslo, Norway."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Halvorsen","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Haukeland University Hospital, Bergen, Norway."},{"name":"The Faculty of Medicine, Department of Clinical Science, University of Bergen, Bergen, Norway."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ola Drange","family":"R\u00f8ksund","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Haukeland University Hospital, Bergen, Norway."},{"name":"The Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Volls\u00e6ter","sequence":"additional","affiliation":[{"name":"Thoracic Department, Norwegian Advisory Unit on Home Mechanical Ventilation, Haukeland University Hospital, Bergen, Norway."},{"name":"Department of Pediatrics, Haukeland University Hospital, Bergen, Norway."},{"name":"The Faculty of Medicine, Department of Clinical Science, University of Bergen, Bergen, Norway."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2021,2,12]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.4187\/respcare.07521210"},{"issue":"1","key":"e_1_3_2_3_2","first-page":"209","article-title":"Assessment of the mechanical efficiency of coughing in healthy young adults","volume":"33","author":"Lawson TV","year":"1967","unstructured":"Lawson TV, , Harris RS. Assessment of the mechanical efficiency of coughing in healthy young adults. Clin Sci, 1967; 33(1):209-224.","journal-title":"Clin Sci"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.nmd.2017.10.008"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.1954.00240300019003"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1378\/chest.125.4.1406"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1378\/chest.104.5.1553"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9610(55)90078-7"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9610(55)90546-8"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1378\/chest.07-1615"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.03.00048102"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1097\/00002060-200206000-00003"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1136\/adc.2009.177832"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1177\/1753466619875928"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-018-5484-2"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1186\/cc11249"},{"key":"e_1_3_2_17_2","first-page":"CD011833","article-title":"Cough augmentation techniques for extubation or weaning critically ill patients from mechanical ventilation","volume":"1","author":"Rose L","year":"2017","unstructured":"Rose L, , Adhikari NK, , Leasa D, , Fergusson DA, , McKim D. Cough augmentation techniques for extubation or weaning critically ill patients from mechanical ventilation. Cochrane Database Syst Rev, 2017; 1:CD011833.","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.4187\/respcare.05663"},{"key":"e_1_3_2_19_2","first-page":"40","article-title":"Comparison of mechanical insufflation-exsufflation and percussors in the treatment of lung infections for children with cerebral palsy","volume":"9","author":"He YL","year":"2013","unstructured":"He YL, , Liao D, , Kang H, , Ke C, , Chen Y, , Liu S, et al. Comparison of mechanical insufflation-exsufflation and percussors in the treatment of lung infections for children with cerebral palsy. J Pediatr Resp Dis, 2013; 9:40-47.","journal-title":"J Pediatr Resp Dis"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.4187\/respcare.06882"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1111\/dmcn.14797"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.29390\/cjrt-2018-014"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13023-020-01366-z"},{"key":"e_1_3_2_24_2","doi-asserted-by":"publisher","DOI":"10.1136\/thoraxjnl-2015-207555"},{"key":"e_1_3_2_25_2","doi-asserted-by":"publisher","DOI":"10.4187\/respcare.05924"},{"key":"e_1_3_2_26_2","doi-asserted-by":"publisher","DOI":"10.1378\/chest.125.4.1400"},{"key":"e_1_3_2_27_2","doi-asserted-by":"publisher","DOI":"10.1212\/01.WNL.0000092018.56823.02"},{"key":"e_1_3_2_28_2","doi-asserted-by":"publisher","DOI":"10.3109\/21678421.2015.1051992"},{"key":"e_1_3_2_29_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0003-9993(95)80547-8"},{"key":"e_1_3_2_30_2","doi-asserted-by":"publisher","DOI":"10.1097\/00002060-199707000-00017"},{"key":"e_1_3_2_31_2","first-page":"27","volume-title":"Laryngeal and tracheobronchial stenosis","author":"Sandhu GS","year":"2016","unstructured":"Physiology and phylogeny of the larynx and trachea. In: Sandhu GS, , Reza Nouraei SA. editors. Laryngeal and tracheobronchial stenosis. San Diego: Plural Publishing; 2016:27-40."},{"key":"e_1_3_2_32_2","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201606-1249CI"},{"key":"e_1_3_2_33_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijporl.2003.08.011"},{"key":"e_1_3_2_34_2","doi-asserted-by":"publisher","DOI":"10.1152\/jappl.1964.19.4.653"},{"key":"e_1_3_2_35_2","doi-asserted-by":"publisher","DOI":"10.1152\/physrev.1989.69.1.33"},{"issue":"4","key":"e_1_3_2_36_2","first-page":"603","article-title":"Relationships among glottis opening, respiratory flow, and upper airway resistance in humans","volume":"43","author":"Baier H","year":"1977","unstructured":"Baier H, , Wanner A, , Zarzecki S, , Sackner MA. Relationships among glottis opening, respiratory flow, and upper airway resistance in humans. J Appl Physiol Respir Environ Exerc Physiol, 1977; 43(4):603-611.","journal-title":"J Appl Physiol Respir Environ Exerc Physiol"},{"key":"e_1_3_2_37_2","volume-title":"The origin of species by means of natural selection: the preservation of favored races in the struggle for life","author":"Darwin C","year":"2009","unstructured":"Darwin C, , Bynum WF. The origin of species by means of natural selection: the preservation of favored races in the struggle for life. New York: AL Burt; 2009."},{"key":"e_1_3_2_38_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1440-1681.1999.02988.x"},{"key":"e_1_3_2_39_2","doi-asserted-by":"publisher","DOI":"10.1097\/WNP.0000000000000187"},{"key":"e_1_3_2_40_2","doi-asserted-by":"publisher","DOI":"10.1034\/j.1600-0404.2001.d01-22.x"},{"key":"e_1_3_2_41_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0272-5231(21)00793-0"},{"issue":"5","key":"e_1_3_2_42_2","first-page":"1269","article-title":"Respiratory movements of the vocal cords","volume":"54","author":"Brancatisano T","year":"1983","unstructured":"Brancatisano T, , Collett PW, , Engel LA. Respiratory movements of the vocal cords. J Appl Physiol Respir Environ Exerc Physiol, 1983; 54(5):1269-1276.","journal-title":"J Appl Physiol Respir Environ Exerc Physiol"},{"issue":"3","key":"e_1_3_2_43_2","first-page":"773","article-title":"Influence of human vocal cord movements on airflow and resistance during eupnea","volume":"52","author":"England SJ","year":"1982","unstructured":"England SJ, , Bartlett DJr, , Daubenspeck JA. Influence of human vocal cord movements on airflow and resistance during eupnea. J Appl Physiol Respir Environ Exerc Physiol, 1982; 52(3):773-779.","journal-title":"J Appl Physiol Respir Environ Exerc Physiol"},{"key":"e_1_3_2_44_2","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm.150.3.8087344"},{"issue":"4","key":"e_1_3_2_45_2","first-page":"1143","article-title":"Respiratory activity of posterior cricoarytenoid muscle and vocal cords in humans","volume":"57","author":"Brancatisano TP","year":"1984","unstructured":"Brancatisano TP, , Dodd DS, , Engel LA. Respiratory activity of posterior cricoarytenoid muscle and vocal cords in humans. J Appl Physiol Respir Environ Exerc Physiol, 1984; 57(4):1143-1149.","journal-title":"J Appl Physiol Respir Environ Exerc Physiol"},{"key":"e_1_3_2_46_2","doi-asserted-by":"publisher","DOI":"10.1378\/chest.127.2.550"},{"key":"e_1_3_2_47_2","doi-asserted-by":"publisher","DOI":"10.1177\/000348940311201002"},{"key":"e_1_3_2_48_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00455-005-0021-1"},{"issue":"5","key":"e_1_3_2_49_2","first-page":"S39","article-title":"The development of cough","volume":"131","author":"Leith DE","year":"1985","unstructured":"Leith DE. The development of cough. Am Rev Respir Dis, 1985; 131(5):S39-42.","journal-title":"Am Rev Respir Dis"},{"key":"e_1_3_2_50_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0272-5231(21)01014-5"},{"issue":"2","key":"e_1_3_2_51_2","first-page":"50","article-title":"Mechanical aids for secretion clearance","volume":"5","author":"Chatwin M","year":"2009","unstructured":"Chatwin M. Mechanical aids for secretion clearance. Int J Respir Care, 2009; 5(2):50-53.","journal-title":"Int J Respir Care"},{"key":"e_1_3_2_52_2","doi-asserted-by":"publisher","DOI":"10.1177\/0003489417694912"},{"key":"e_1_3_2_53_2","doi-asserted-by":"publisher","DOI":"10.1002\/lio2.44"},{"key":"e_1_3_2_54_2","doi-asserted-by":"publisher","DOI":"10.1378\/chest.110.6.1566"},{"key":"e_1_3_2_55_2","doi-asserted-by":"publisher","DOI":"10.1080\/21678421.2017.1335324"},{"key":"e_1_3_2_56_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.rmed.2018.01.012"},{"key":"e_1_3_2_57_2","doi-asserted-by":"publisher","DOI":"10.1159\/000364911"},{"key":"e_1_3_2_58_2","doi-asserted-by":"publisher","DOI":"10.4187\/respcare.07682"},{"key":"e_1_3_2_59_2","first-page":"315","article-title":"Mechanical production of expiratory flow rates surpassing the capacity of human coughing","volume":"66","author":"Barach AL","year":"1953","unstructured":"Barach AL, , Beck G, , Smith W. Mechanical production of expiratory flow rates surpassing the capacity of human coughing. Trans Assoc Am Physicians, 1953; 66:315-324.","journal-title":"Trans Assoc Am Physicians"},{"key":"e_1_3_2_60_2","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0000000000004015"},{"key":"e_1_3_2_61_2","doi-asserted-by":"publisher","DOI":"10.1177\/000348940811700501"},{"key":"e_1_3_2_62_2","doi-asserted-by":"publisher","DOI":"10.1136\/thx.49.9.896"},{"key":"e_1_3_2_63_2","doi-asserted-by":"publisher","DOI":"10.1017\/S002221510700610X"},{"issue":"8","key":"e_1_3_2_64_2","first-page":"S22","article-title":"Presentation of ALS to the otolaryngologist\/head and neck surgeon: getting to the neurologist","volume":"53","author":"Hillel A","year":"1999","unstructured":"Hillel A, , Dray T, , Miller R, , Yorkston K, , Konikow N, , Strande E, et al. Presentation of ALS to the otolaryngologist\/head and neck surgeon: getting to the neurologist. Neurology, 1999; 53(8 Suppl 5):S22-25.discussion S35-26.","journal-title":"Neurology"},{"key":"e_1_3_2_65_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0892-1997(96)80028-2"},{"key":"e_1_3_2_66_2","doi-asserted-by":"publisher","DOI":"10.1002\/lary.28158"},{"key":"e_1_3_2_67_2","doi-asserted-by":"publisher","DOI":"10.1177\/0883073813501871"},{"key":"e_1_3_2_68_2","doi-asserted-by":"publisher","DOI":"10.1111\/dmcn.14060"},{"key":"e_1_3_2_69_2","doi-asserted-by":"publisher","DOI":"10.1080\/21678421.2018.1510011"},{"key":"e_1_3_2_70_2","doi-asserted-by":"publisher","DOI":"10.1152\/jappl.1993.75.3.1088"},{"key":"e_1_3_2_71_2","doi-asserted-by":"publisher","DOI":"10.1016\/0140-6736(91)92593-Q"},{"key":"e_1_3_2_72_2","doi-asserted-by":"publisher","DOI":"10.1152\/jappl.1995.79.1.186"},{"key":"e_1_3_2_73_2","doi-asserted-by":"publisher","DOI":"10.1152\/jappl.1995.79.1.176"},{"key":"e_1_3_2_74_2","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp-2015-312606"},{"key":"e_1_3_2_75_2","doi-asserted-by":"publisher","DOI":"10.4187\/respcare.04784"},{"key":"e_1_3_2_76_2","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm.153.5.8630611"},{"key":"e_1_3_2_77_2","doi-asserted-by":"publisher","DOI":"10.1152\/japplphysiol.00891.2006"},{"key":"e_1_3_2_78_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.resp.2018.07.006"},{"key":"e_1_3_2_79_2","doi-asserted-by":"publisher","DOI":"10.1097\/PHM.0b013e3182a4708f"},{"key":"e_1_3_2_80_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.apmr.2019.06.012"},{"issue":"64","key":"e_1_3_2_81_2","first-page":"1271","article-title":"Laryngeal responses and airflow geometry in ALS during mechanically assisted cough","volume":"56","author":"Andersen T","year":"2020","unstructured":"Andersen T, , Hov B, , Fondenes O, , Clemm H, , Halvorsen T, , Drange R\u00f8ksund O, et al. Laryngeal responses and airflow geometry in ALS during mechanically assisted cough. Eur Resp J, 2020; 56(Suppl 64):1271.","journal-title":"Eur Resp J"},{"key":"e_1_3_2_82_2","doi-asserted-by":"publisher","DOI":"10.1002\/ccr3.3905"},{"key":"e_1_3_2_83_2","doi-asserted-by":"publisher","DOI":"10.1080\/10255842.2017.1360872"},{"key":"e_1_3_2_84_2","doi-asserted-by":"publisher","DOI":"10.4187\/respcare.06478"},{"key":"e_1_3_2_85_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.pulmoe.2019.02.008"},{"key":"e_1_3_2_86_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0b013e318228c0fb"},{"key":"e_1_3_2_87_2","doi-asserted-by":"publisher","DOI":"10.3233\/THC-1997-5403"},{"key":"e_1_3_2_88_2","doi-asserted-by":"publisher","DOI":"10.1002\/ppul.24606"},{"key":"e_1_3_2_89_2","doi-asserted-by":"publisher","DOI":"10.1007\/978-94-007-4488-2"},{"key":"e_1_3_2_90_2","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2016.00212"},{"key":"e_1_3_2_91_2","doi-asserted-by":"publisher","DOI":"10.1044\/1058-0360(2008\/07-0014)"},{"key":"e_1_3_2_92_2","doi-asserted-by":"publisher","DOI":"10.1097\/00005537-199711000-00002"},{"key":"e_1_3_2_93_2","doi-asserted-by":"publisher","DOI":"10.1038\/ncpneuro0853"},{"key":"e_1_3_2_94_2","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/123.1.125"},{"key":"e_1_3_2_95_2","doi-asserted-by":"publisher","DOI":"10.1177\/000348949110000815"},{"key":"e_1_3_2_96_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvoice.2013.02.010"},{"key":"e_1_3_2_97_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.mlg.0000184528.16229.ba"},{"key":"e_1_3_2_98_2","doi-asserted-by":"publisher","DOI":"10.1002\/lary.26532"},{"key":"e_1_3_2_99_2","doi-asserted-by":"publisher","DOI":"10.3389\/fped.2020.00537"},{"key":"e_1_3_2_100_2","doi-asserted-by":"publisher","DOI":"10.1590\/S0104-56872008000400005"},{"key":"e_1_3_2_101_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-017-4151-z"},{"key":"e_1_3_2_102_2","doi-asserted-by":"publisher","DOI":"10.1136\/thoraxjnl-2016-208919"},{"key":"e_1_3_2_103_2","doi-asserted-by":"publisher","DOI":"10.1097\/00002060-200208000-00004"},{"key":"e_1_3_2_104_2","doi-asserted-by":"publisher","DOI":"10.4187\/respcare.06674"},{"key":"e_1_3_2_105_2","doi-asserted-by":"publisher","DOI":"10.4187\/respcare.05965"},{"key":"e_1_3_2_106_2","doi-asserted-by":"publisher","DOI":"10.4187\/respcare.07904"},{"issue":"3","key":"e_1_3_2_107_2","first-page":"569","article-title":"The relative mechanical effectiveness and efficiency of successive voluntary coughs in healthy young adults","volume":"34","author":"Harris RS","year":"1968","unstructured":"Harris RS, , Lawson TV. The relative mechanical effectiveness and efficiency of successive voluntary coughs in healthy young adults. Clin Sci, 1968; 34(3):569-577.","journal-title":"Clin Sci"}],"container-title":["Respiratory Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.4187\/respcare.08960","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.4187\/respcare.08960","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.4187\/respcare.08960","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,6]],"date-time":"2026-04-06T08:57:08Z","timestamp":1775465828000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.4187\/respcare.08960"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,2,12]]},"references-count":106,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2021,7]]}},"alternative-id":["10.4187\/respcare.08960"],"URL":"https:\/\/doi.org\/10.4187\/respcare.08960","relation":{},"ISSN":["0020-1324"],"issn-type":[{"value":"0020-1324","type":"print"}],"subject":[],"published":{"date-parts":[[2021,2,12]]}}}