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Cough plays a fundamental role in the maintenance of respiratory health primarily through removal of mucus. There is a heterogeneous group who are unable to cough effectively, some include those with respiratory muscle weakness, intrinsic lung disease, and as a result of trauma or surgery. An impaired cough can result in airflow obstruction, increased work of breathing and ventilation-perfusion mismatch, causing gas exchange abnormalities and serving as a source of infection and inflammation. These can lead to hospital admission if untreated due to life-threatening respiratory failure in addition to many physical, psychosocial and economic implications. Mechanical insufflation-exsufflation is a technique that can be used to augment a cough. This portable and minimally invasive technique uses positive pressure to deliver a maximal lung inhalation to the upper airway, which is then followed by an abrupt switch to negative pressure. The rapid change from positive to negative pressure simulates the airflow changes that occur during a normal cough and aim to provide adequate shear and velocity to loosen and move secretions toward the mouth. This allows for removal of secretions. The role of mechanical-insufflation-exsufflation for those with an impaired cough is poorly understood therefore, further exploration into this device is warranted. The overall aim of this programme of research was to gain an understanding of the clinical role of mechanical insufflation-exsufflation in impaired cough. An evidencebased healthcare approach was taken by identifying and interpreting best external evidence, individual clinical expertise, and patient values and expectations. In order to achieve this four different studies were conducted, each one building on the previous study. The systematic review of the literature determined that there is evidence that mechanical insufflation-exsufflation can be effective in neurological conditions (n=43 original studies, mixed methodologies). A recommendation was made for mechanical insufflation-exsufflation in neuromuscular disease and spinal cord injured populations.