BlueCross BlueShield of Tennessee Medical Policy Manual

Mechanical In-Exsufflator (Cough Machine)


The mechanical in-exsufflator, or cough machine, is a portable machine intended to stimulate a cough for individuals unable to cough or clear secretions effectively. It works by gradually applying a positive pressure to the airway, then rapidly shifting to a negative pressure. The rapid shift in pressure, via facemask or mouthpiece, produces a high expiratory flow rate from the lungs. A cough is stimulated, which assists in clearing broncho-pulmonary secretions.





Careful consideration should be given before the mechanical in-exsufflator is used for individuals with any of the following conditions: History of bullous emphysema; known susceptibility to pneumothorax or pneumo-mediastinum; or known to have had a recent barotrauma.


BlueCross BlueShield Association. Medical Policy Reference Manual. (4:2004). Mechanical insufflation-exsufflation as a expiratory muscle aid (1.01.21). Retrieved April 2, 2012 from BlueWeb. (12 articles and/or guidelines reviewed)

Finder, J. D. (2010). Airway clearance modalities in neuromuscular disease. Paediatric Respiratory Reviews, 11 (1), 31-34.

Guerin, C., Bourdin, G., Leray, V., Delannoy, B., Bayle, F., Germain, M., et al. (2011). Performance of the coughassist insufflation-exsufflation device in the presence of an endotracheal tube or tracheostomy tube: A bench study. Respiratory Care, 56 (8), 1108-1114.

Homnick, D. N. (2007). Mechanical insufflation-exsufflation for airway mucus clearance. Respiratory Care, 52 (10), 1296-1305.

Miller, R. G., Jackson, C. E., Kasarskis, E. J., England, J. D., Forshew, D., Johnston, W., et al. (2009). Practice parameter update: The care of the patient with amyotrophic lateral sclerosis: Drug, nutritional, and respiratory therapies (an evidence-based review): Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology, 73 (15), 1218-1226.

National Guideline Clearinghouse. (2010, July). Motor neurone disease. The use of non-invasive ventilation in the management of motor neurone disease. Retrieved April 2, 2012 from

Striegl, A. M., Redding, G. J., Diblasi, R., Crotwell, D., Salyer, J., & Carter, E. R. (2011). Use of a lung model to assess mechanical in-exsufflator therapy in infants with tracheostomy. Pediatric Pulmonology, 46, 211-217.

Toussaint, M. (2011). The use of mechanical insufflation-exsufflation via artificial airways. Respiratory Care, 56 (8), 1217-1219.

U. S. Food and Drug Administration (2008, January). Center for Devices and Radiological Health. 510(k) Premarket Notification Database. K072292. Retrieved April 2, 2012 from




Policies included in the Medical Policy Manual are not intended to certify coverage availability. They are medical determinations about a particular technology, service, drug, etc. While a policy or technology may be medically necessary, it could be excluded in a member's benefit plan. Please check with the appropriate claims department to determine if the service in question is a covered service under a particular benefit plan. Use of the Medical Policy Manual is not intended to replace independent medical judgment for treatment of individuals. The content on this Web site is not intended to be a substitute for professional medical advice in any way. Always seek the advice of your physician or other qualified health care provider if you have questions regarding a medical condition or treatment.

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