From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Managing increased secretions during viral illnesses in cerebral palsy patients requires a multi-faceted approach, with the most recent and highest quality study suggesting that mechanical insufflation-exsufflation devices, such as CoughAssist, can be beneficial in shortening the duration of airway clearance 1.
Key Interventions
- Increase the frequency of airway clearance techniques, including chest physiotherapy, postural drainage, and assisted coughing several times daily.
- Consider using mechanical insufflation-exsufflation devices (such as CoughAssist) if available, with settings typically at 30-40 cmH2O for insufflation and -30 to -40 cmH2O for exsufflation.
- Pharmacologically, glycopyrrolate (0.04-0.1 mg/kg/dose every 4-8 hours) or scopolamine patches (1.5 mg patch every 72 hours) can reduce secretion production.
- Ensure adequate hydration to maintain secretion viscosity while avoiding overhydration.
- Nebulized saline (3-5 mL of 0.9% solution 3-4 times daily) can help loosen thick secretions.
- Positioning is crucial - elevate the head of the bed 30-45 degrees and regularly change positions to prevent secretion pooling.
Importance of Early Intervention
These interventions are particularly important in cerebral palsy patients who often have impaired cough reflexes, weak respiratory muscles, and difficulty coordinating swallowing, which increases their risk of aspiration and respiratory complications during viral illnesses, as highlighted in a recent study 2.
Multidisciplinary Approach
A multidisciplinary approach to care, including regular assessment of risk factors and effective partnerships between healthcare teams, individuals with cerebral palsy, and families, is essential for preventing and managing respiratory disease in this population 2.
Additional Considerations
Other factors to consider include the evaluation and management of oropharyngeal dysphagia, gastrointestinal dysfunction, and malnutrition, as well as the potential use of prophylactic antibiotics in patients with recurrent exacerbations 3, 4.