Initial placement of the Valve may stimulate a cough, due to the reintroduction of exhalation and sensation through the upper airway. When airflow is absent, as with an inflated cuff, there is a tendency for secretions to pool in the back of the throat. When secretions are not felt in the upper airway you may not spontaneously cough or swallow.

Placement of the Valve redirects exhalation through the upper airway, restoring sensation, and stimulating a cough. Coughing may continue until the secretions have settled, or have moved into a position that will allow you to remove them. This is beneficial as you now have a more effective secretion clearing mechanism in place with the Valve on.

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Usually, coughing subsides, and use of the Valve becomes more comfortable. Keep in mind that more than one suctioning attempt may be required. When coughing persists, and it is not improved by suctioning, or it is uncomfortable to breathe while using the Valve, remove the Valve immediately and speak with your doctor regarding possible causes.

There could be several causes affecting your ability to tolerate using the Valve due to persistent coughing that can include:

• Thick secretions may require more aggressive pulmonary hygiene.
• Changes in your airway that make it difficult to breathe easily may stimulate a dry cough. Airway changes can be due to scar tissue development and should be checked by a physician.
• The tracheostomy tube is too large or the cuff on your tube takes up too much room in your airway. You may want to discuss with your physician downsizing the tracheostomy tube, or changing to a cuffless tube.
• Hypersensitivity that may benefit from medication to desensitize the airway.

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It is important to note and tell your doctor when the coughing began. The following questions will help you and your doctor discover the possible causes of your discomfort:

• Did the coughing start immediately the first time you wore the Valve and has never improved?
• Did the coughing begin several weeks after you first began to use the Valve?
• Were there any changes made regarding your airway that may have triggered the coughing, such as a tracheostomy tube change?
• Does your cough sound wet or dry?

NOTE: Do not use the Passy Muir Valve again until you have received clearance from your doctor.

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