In-Exsufflator/CoughAssist Testimonial


"The Secret to Ventilator Health" 

- By Bill Miller -

An apple a day may keep the doctor away, but Respironics' In-Exsufflator (now called CoughAssist) keeps pneumonia at bay.  Anyone with difficulty expelling secretions can benefit from this product, whether he or she needs assistance short-term (hospital stay) or long-term (mostly permanent condition affecting his or her respiratory system).

Below is a letter extolling the virtues of a product that every person on a ventilator should have.  Please share the following information with any ventilator user and/or their doctors and caregivers.  I invite questions and comments and encourage critique from people "in the know."

UPDATED 3/9/2008: I wrote the original version of what is below in early 2000, but have updated it periodically, and my track record is even more impressive now considering I still haven't been suctioned since I left Shepherd in November of 1997, and I haven't had any respiratory related hospitalizations, as of today, March 9th, 2008...

Bill Miller :-)
C1-2 Quadriplegic with a 206 High Bowling Game
Co-founder of Manufacturing Genuine Thrills Inc. d/b/a MGT
My blog:
Business website:
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My name is Bill Miller and I'm a 31-year old quadriplegic and ventilator user.  August 23rd, 1997, two days before I was to begin my senior year at the University of Florida, I tripped in my room and ended up a C1-2, like late actor and real-life Superman Christopher Reeve.

Despite being dependent on a machine to breathe, I am proud to say that I have been able to live at home with my family and I've been happy, healthy, and pneumonia-free ever since my initial hospitalization.  That's right, not once have I been hospitalized with pneumonia (or any respiratory issue) since I've been home -- which is especially noteworthy since pneumonia is a chronic problem for ventilator-dependent individuals.  More gravely, it's also a leading cause of death for us.

What's my secret?

The single most valuable piece of equipment that I have (besides my ventilators) accompanies me everywhere I go.  It's Respironics' CoughAssist machine (I have an early model of the CoughAssist that was called an "In-Exsufflator" and that's what I call it below) and every ventilator-dependent person should have AT LEAST ONE.  I have two, and Christopher Reeve had three (his death wasn't respiratory related).

My pulmonologist, Dr. Humberto Delgado, agrees that the In-Exsufflator has made a tremendous difference in my life and would like to see widespread use of Respironics' In-Exsufflator with ventilator dependent persons.

Able-bodied individuals cough up secretions by filling their lungs with air, and then forcibly contracting their diaphragm in a coughing manner, which brings up the secretions as the air is exhaled.  However, if a person requires a ventilator to breathe, then they haven't the diaphragm control or ability to cough up respiratory ailments on their own.

But there had to be a way to remove secretions and relieve respiratory distress from individuals on ventilators.  One answer: suctioning.  Remove the air supply, then stick a plastic tube down through the airway and into the lungs and hope the tiny hole at the end of the catheter will find the problem and hold on to it as suction is applied to the other end.

It would be like eating mashed potatoes and gravy with a straw -- while blindfolded.  It would work OK with the gravy, but the potatoes?  You must work quickly because you can't breathe while doing this.  Every miss you make, every stab you take, you're not hitting the plate -- you're causing trauma to your lungs and airway.

Suctioning is very uncomfortable.  The "foreign object" inside your lungs literally gags you.  It's invasive.  It's traumatic.  It's a difficult skill to master and administer and at its best, it pulls out dribbles of "gravy" and leaves the big stuff behind.  There must be a better way.

There is -- and it's easier on the checkbook, too.

Respironics acquired the J. H. Emerson Co., which gave us the In-Exsufflator (and its successor, the CoughAssist).  The In-Exsufflator (originally described as a "cough machine") is a magnificent device designed to simulate the body's natural way of clearing secretions.  The In-Exsufflator fills the lungs with air, then with the flip of a switch and an "assist cough," pulls out the air -- and secretions -- easily, effectively and efficiently.  The positive adjectives used to describe the In-Exsufflator -- a machine used on me several times a day -- don't end with effective and efficient.  It's a wonderful machine.

It's a big, comfortable breath in, and then a WHOOSH out -- potatoes, gravy and all.  It's over in seconds and relief is immediate.  It's a noninvasive procedure that's not traumatic and it's an easy skill for a single person to perform.  Several of my friends and all of my immediate family members have learned to in-exsufflate me.  From the caregiver standpoint, would you rather give me a big breath of air with an In-Exsufflator, or remove my air supply, stick a plastic tube down into my lungs and watch me gag in pain?

The In-Exsufflator indeed is the reason I haven't been in the hospital with a bout of pneumonia (knock-on-wood and thank you God!).  In fact, I haven't had any significant respiratory ailments whatsoever nor have I been suctioned -- since the day I LEFT Shepherd.

"Wait a second, if the experts at Shepherd use In-Exsufflators, then why were you suctioned on your last day there," you ask?  Please read on.

Yes, it's easier to in-exsufflate than suction.  Yes, in-exsufflating is more comfortable than suctioning.  Yes, in-exsufflating is more convenient.  Yes, it's more effective.  Yes, it's more efficient.  Yes, the experts at Shepherd use In-Exsufflators -- but they ONLY taught suctioning to my family.

No, that doesn't make any sense.

At Shepherd Center, they taught my family to suction, and not to in-exsufflate, because it was RARE that a person on a vent would have an In-Exsufflator when they went home!  Fortunately, now insurance and/or Medicare or Medicaid have started approving the CoughAssist for patients in long-term scenarios.

Denying the In-Exsufflator purchase doesn't/didn't make monetary cents either.  In short term scenarios, the cost of sterile catheters and a suction pump may be cheaper than an In-Exsufflator -- never mind the trouble and trauma they cause to the airway.  However in long-term situations, the In-Exsufflator is basically a one-time cost of $3100 (that's what it was roughly 10.5 years ago; I'm not sure of the cost now).  Whereas sterile suction kits and catheters are a life-sustaining repetitive charge that insurance companies and/or Medicaid cannot refuse.  Let's face it, extended care with sterile, non-reusable suction catheters is a virtual goldmine for medical supply companies.  AND -- call it common sense or preventive medicine -- just one hospitalization for pneumonia can EASILY cost double or triple the purchase price of an In-Exsufflator.  Pay a few thousand once, or repeatedly pay several thousand in the future, that's the choice for insurance companies/Medicaid/Medicare.

I've been paralyzed and ventilator dependent for more than 10.5 years now.  We gave away my suction machine about 10 years ago (when we acquired my second In-Exsufflator).  From what I've heard, most ventilator users have a serious respiratory infection that requires hospitalization, typically for multiple weeks, at least once a year.  Again, I've had a grand total of zero!  I thank God and my caregivers who in-exsufflate me as needed (about 5 times per day) to prevent serious respiratory infections, but the bottom line is that the In-Exsufflator/CoughAssist has kept me from respiratory-related hospitalization.

For more information, visit Respironics CoughAssist page here:


Bill Miller :-)
C1-2 Quadriplegic with a 206 High Bowling Game
Co-founder of Manufacturing Genuine Thrills Inc. d/b/a MGT
My blog:
Business website:
Personal website:

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