What is it?
Spinal cord injuries above the lower thoracic levels weaken or paralyze the muscles you use to breathe deeply and to cough. The diaphragm comes from C3–C5. Below that, the abdominal and intercostal muscles help force air out — those are the cough generators.
Cough strength matters because clearing mucus is how your lungs stay healthy. After SCI, mucus that would normally come out with one strong cough can sit in the airways and grow into pneumonia.
Pneumonia is the leading cause of rehospitalization for higher-level SCI. It is also the most preventable.
Trouble signs
- New or louder productive cough
- Yellow, green, brown, or blood-tinged mucus
- Fever or chills
- Trouble breathing or feeling more short of breath than usual
- Fast heart rate
- Pulse oximeter reading below your usual baseline (often 95% or higher)
- New fatigue, confusion, or change in thinking
- Pain on one side of the chest with a deep breath
What you can do every day
- Deep breathing. Take a slow, full breath, hold 2 seconds, exhale slowly. Repeat 10 breaths, three times a day.
- Incentive spirometer. A simple plastic device — inhale slowly to lift the ball or piston. Aim for the goal your team set. Use 10 times every hour while awake during illness.
- Hydration. Thick mucus is hard to cough out. Aim for the fluid target your team set.
- Quad cough (assisted cough). A caregiver places hands below your rib cage and pushes up and in as you exhale. This boosts cough force at C5–T6 levels. Train family in inpatient rehab.
- Avoid smoke. Cigarettes, vaping, wood smoke — all worsen mucus.
Equipment that helps
- Cough-assist machine (mechanical insufflation-exsufflation, e.g., Philips CoughAssist E70). Pushes air in, then sucks it out — simulating a strong cough. Used 1–3 times per day for high-tetraplegic patients, more during illness.
- Suction unit. Portable suction is essential at C1–C4 levels.
- Portable ventilator and ambu bag. For C1–C3 patients.
💡 Vaccines (annual or as scheduled)
- Influenza — every fall.
- Pneumococcal — both PCV20 (or PCV15 + PPSV23) per current ACIP recommendations. Talk to your primary care doctor.
- COVID-19 — current recommended schedule.
- RSV — newer vaccine, ask your doctor if you qualify.
🚨 Call your doctor or 911 if
- Sustained fever above 101°F.
- Trouble breathing — gasping, can't finish a sentence.
- Oxygen saturation below your usual baseline by 3% or more.
- Confusion, drowsiness, or someone says you "do not seem like yourself."
- Chest pain on one side that gets worse with breathing.
At your next clinic visit
Bring a list of any breathing-related events in the last 6 months, your home pulse oximeter readings, and your vaccine record. If you use cough-assist or suction, bring usage stats.
Education only. Not medical advice. If you have a clinical question, talk to your rehab team. For emergencies call 911.