Pertussis, or whooping cough, is a severe, potentially life-threatening disease caused by the bacteria Bordetella pertussis and is one of the most prevalent vaccine-preventable diseases in the United States.¹ The classic presentation of pertussis occurs in unvaccinated children younger than 10 years who develop paroxysms of cough followed by forced inspiratory efforts (a whoop) and posttussive emesis.² The coughing spells may lead to gagging, apnea, and cyanosis. Older children and adults often experience mild or asymptomatic disease. Continued outbreaks of pertussis may be due to several factors, including lower vaccination rates, waning immunity in previously vaccinated adolescent and adult populations, and genetic changes in the circulating strains of pertussis.^3,4 

Supportive care is the mainstay of management for pertussis, although antimicrobial treatment with macrolides is recommended early in the course of the disease (within 7 days of the onset) and in high-risk individuals (such as infants and pregnant women).⁵ Prevention includes postexposure antimicrobial prophylaxis for all household and close contacts and age-appropriate immunization against pertussis. 

Symptomatic therapies such as bronchodilators, corticosteroids, antitussive agents, and antihistamines have not proven to be effective for pertussis-related cough.⁵ Osteopathic manipulative treatment (OMT) offers a potentially useful adjuvant to the traditional supportive care that is provided to patients with pertussis. Understanding the anatomy and neuropathophysiologic process of the cough reflex helps identify key areas that may be evaluated and treated with OMT. The diaphragm may be assessed, as it is the main muscle of respiration and facilitates venous and lymphatic return.⁶ Diaphragmatic dysfunction can occur as a primary dysfunction or as the result of a dysfunction at or near the diaphragm's attachments, including ribs 6-12, lumbar vertebrae L1-3, and the xiphoid process.⁷ The cervical spine may also be assessed, as the diaphragm receives its innervation from the phrenic nerve (C3-C5). The occipitoatlantal region (OA) may also be assessed, as vagus nerve afferents and efferents are an integral part of the cough reflex.⁸ Paroxysms of coughing may lead to somatic dysfunction of any of these listed areas, among others. 

The video demonstrates the balanced ligamentous tension technique of the thoracic diaphragm, which is a passive technique and may be used for an infant or child with pertussis.⁹ 

Contraindications to this type of assessment and treatment include lower rib or vertebral fractures, as well as malignant neoplasm, open wounds, incisions, or infection in the areas where the physician's hands are placed. Successful treatment should optimize respiratory biomechanics while facilitating venous and lymphatic return.^6,7 This technique can be used with patients of all ages with pertussis (and other respiratory illnesses), including newborns and infants, who are the most vulnerable. Assessing and treating the diaphragm in patients with illnesses like pertussis may aid in symptomatic and physiologic improvement.⁶