Using voluntary cough to detect penetration and aspiration during oropharyngeal swallowing in patients with Parkinson disease

Teresa Pitts, Michelle Troche, Giselle Mann, John Rosenbek, Michael S. Okun, Christine Sapienza

Research output: Contribution to journalArticlepeer-review

55 Scopus citations

Abstract

Background: Identification of people with Parkinson disease (PD) who are at risk for aspiration is important, especially because of the high prevalence of aspiration pneumonia. Methods: Fifty-eight consecutive patients (Hoehn and Yahr stage II-III; average age 72.3) were enrolled in the study. Measures of airflow during voluntary cough production and the degree of penetration/aspiration on a 3-oz oropharyngeal swallow task, derived from videofluorographic images, were examined. Results: To detect at-risk people (those with penetration and/or aspiration on the 3-oz swallow task), four objective measures of voluntary cough (compression phase duration [CPD], expiratory phase rise time [EPRT], expiratory phase peak flow [EPPF], and cough volume acceleration [CVA)]) were collected. CPD, EPRT, EPPF, and CVA measurements produced significant area under the curve (AUC) analyses and likelihood ratios equal to 0.83:2.72, 0.71:2.68, 0.69:1.75, and 0.78:18.42, respectively. CPD, EPRT, EPPF, and CVA measurements demonstrated sensitivities of 95.83%, 70.83%, 87.50%, and 84.53%, and specificities of 64.71%, 73.53%, 50.01%, and 97.06%, respectively. For detection of aspiration, EPPF was significantly associated with an AUC = 0.88 and with an EPPF, 5.24, which had a sensitivity of 57.15% and a specificity of 100%. Conclusions: The data from this pilot study suggest that in patients with PD, objective airflow measures from voluntary cough production may identify at-risk penetrator/aspirators. To our knowledge, this is the first study to evaluate the discriminative ability of voluntary cough airflow characteristics to model airway compromise in people with PD.

Original languageEnglish (US)
Pages (from-to)1426-1431
Number of pages6
JournalChest
Volume138
Issue number6
DOIs
StatePublished - Dec 1 2010
Externally publishedYes

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

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