Khamiees et al evaluated the strength of cough in patients with an endotracheal tube. These measures can be applied to nonintubated patients as well. The authors are from Bridgeport Hospital and Yale University School of Medicine.
Measures of cough strength:
(1) clinical grade
(2) white card test (WCT)
Cough Strength
Grade
no cough on command
0
no audible cough but audible movement of air
1
barely audible cough
2
clearly audible cough
3
stronger cough
4
multiple sequential strong coughs
5
Cough Grade
Cough Strength
0
absent
1 or 2
weak
3 to 5
strong
The White Card Test (WCT) consisted of holding a white 3x5 inch file card 1-2 cm from the end of patient's endotracheal tube while the patient coughed.
The presence of any wetness on the card indicates a positive test. The absence of wetness indicates a negative test and correlates with an absent or weak cough.
Performance:
• The WCT could be negative in a patient who is dehydrated.
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