A 9-year-old boy with congenital muscular dystrophy requires assistance with airway clearance after experiencing an ineffective cough. Which recommendation should the specialist make?

The recommendation to use an in-exsufflator is appropriate for a 9-year-old boy with congenital muscular dystrophy who is struggling with airway clearance due to ineffective coughing. An in-exsufflator works by delivering a positive pressure followed by a negative pressure, mimicking a natural cough. This helps mobilize secretions and enhances airway clearance, which is crucial for children with muscular dystrophy, who may have compromised respiratory muscle function and ineffective cough reflexes.

In contrast, cool aerosol, while it may provide moisture and some symptomatic relief, does not directly assist with mucus clearance or stimulate an effective cough. A PEP (Positive Expiratory Pressure) device can assist with airway clearance by creating oscillations in the airways, but it relies on the patient to have some ability to generate a productive cough, which might not be adequate for this boy. IPPB (Intermittent Positive Pressure Breathing) therapy is primarily used to improve ventilation and deliver medications, and it does not specifically enhance the airway clearance as effectively as an in-exsufflator would. Thus, recommending the in-exsufflator is a targeted approach to support the child's specific needs for airway clearance in the context of congenital muscular dystrophy.