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Ishikawa Y, Bach JR, Komaroff E, Miura T, Jackson-Parekh R: Cough augmentation in Duchenne muscular dystrophy. Am J Phys Med Rehabil 2008;87:726–730.The purpose of this work was to compare the relative importance of deep lung insufflation with the abdominal thrust and their combination in augmenting cough peak flows (CPF).Unassisted CPF and CPF assisted by air stacking to deep lung volumes (CPFair), assisted by abdominal thrusts (CPFthrust), and assisted by both air stacking and abdominal thrusts (aCPF) were measured for 61 patients with Duchenne muscular dystrophy (DMD).Overall, mean unassisted CPF were 138 ± 70 liters/min, CPFthrust were 204 ± 75 liters/min, CPFair were 236 ± 68 liters/min, and aCPF were 302 ± 78 liters/min. The differences between each were statistically significant (P < 0.0001).Thus, air stacking was significantly more effective than abdominal thrust in increasing CPF, but the combination was the most effective. The CPF of the quartile of patients with the lowest unassisted CPF were also significantly (P ≤ 0.04) more augmented by air stacking and thrusting than for the milder quartiles of patients. Thus, the greatest improvements in CPF were for patients with the weakest coughs.