3.01 Cough and Deep Breathing
Category: UWHC Clinical Policy
Policy Number: 3.01
Effective Date: June 1, 2016
Section: Respiratory Care Services
Removal of bronchial secretions via coughing is accomplished when a maximal deep inspiration is performed
followed by closure of the glottis. Inspiration should be slow and near maximal, followed by a breath hold of
one to four seconds.
A. All patients will be assessed by a Respiratory Care Practitioner (RCP).
B. Therapy will be provided in accordance with a provider’s order.
A. Review and acknowledge provider’s order.
B. Review patient’s chart.
C. Introduce yourself to the patient and/or family. Explain the reason for the procedure.
D. Assess the patient throughout the procedure.
E. If possible, assist the patient into an upright seated position.
F. To develop an effective cough a deep inspiration with special emphasis on good filling of the lungs.
G. Each patient is to be coughed following the above technique during a 10-15 minute therapy
period. Patients should also be encouraged to use the above technique between therapy sessions
as frequently as possible. If the cough produces pain, as after abdominal surgery, a pillow is
placed over the incision and held firmly in place to reduce pain.
H. Following are characteristics of efficient deep breathing:
1. Elimination of shoulder elevation
2. Diaphragmatic or belly breathing is effective in increasing inspiratory volumes. By placing one
hand on the abdomen, just below the diaphragm, instruct the patient to push your hand out and
breathe in deeply.
3. Breath holding should improve the distribution of inspired gas as well as maintaining an
increased pressure to improve alveolar opening.
4. Expiration should be a passive maneuver to avoid airway collapse. If the patient has a history of
obstructive lung disease, pursed lip expiration is effective in maintaining airway patency and
prolonging the expiration phase to a more normal functional residual capacity level.
A. AARC Clinical Practice Guidelines
1. Incentive Spirometry
2. Directed Cough
B. HFFY’s 4402, 4403,5445
Approved by Director and Medical Director of Respiratory Care
Original copy of this Policy & Procedure is available in the Respiratory Care Office [E5/489].