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Controlled Clinical Trial
. 2022 Dec;37(6):1814-1821.
doi: 10.1007/s00455-022-10439-z. Epub 2022 Apr 16.

A New Therapeutic Approach for Dystussia and Atussia in Neurogenic Dysphagia: Effect of Aerosolized Capsaicin on Peak Cough Flow

Eliane Lüthi-Müller  1 , Jan Kool  2 , Veit Mylius  2   3 , Paul Diesener  4
Affiliations
Controlled Clinical Trial

A New Therapeutic Approach for Dystussia and Atussia in Neurogenic Dysphagia: Effect of Aerosolized Capsaicin on Peak Cough Flow

Eliane Lüthi-Müller et al. Dysphagia. 2022 Dec.

Abstract

Swallowing and cough are crucial components of airway protection. In patients with neurogenic dysphagia (ND), there is a high prevalence of dystussia (impaired cough) and atussia (absence of cough). As a result, the ability to detect and remove aspirated material from the airway decreases, exacerbating the sequelae associated with ND, including aspiration pneumonia, a leading cause of mortality in ND. This controlled intervention study aimed to quantify the cough response to aerosolized capsaicin (AC) in patients with ND and assess the potential of AC as a therapeutic tool in treating ND-related dystussia and atussia. Furthermore, we propose a novel application method that enables AC treatment to be performed at home. Spirometry was used to measure peak cough flow (PCF) of voluntary cough (cough on command) and reflexive cough (cough secondary to pharyngeal exposure to AC) in 30 subjects with and 30 without ND. The capsaicin aerosol was generated by adding 1-10 drops of liquid cayenne extract (1.5-2% capsaicin) to 100 mL carbonated water (0.00075-0.001% to 0.0075-0.01% capsaicin). Voluntary PCF in the ND group was significantly lower than in the control group (p < 0.001), while there was no significant difference in reflexive PCF (p = 0.225). Within the ND group, reflexive PCF was significantly higher than voluntary PCF (p = 0.001), while in healthy controls, reflexive PCF was significantly lower (p < 0.001). The data show that AC increased the tracheobronchial clearance efficacy in ND patients with dystussia and atussia, as it enabled subjects to access their individual cough potential, which is present, but inaccessible, due to neurological disorder.

Keywords: Aerosolized capsaicin; Aspiration pneumonia; Dystussia; Neurogenic dysphagia; Peak cough flow; Tracheobronchial clearance.

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Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
Patient during voluntary peak cough flow (PCF) measurement
Fig. 2
Fig. 2
Patient during reflexive peak cough flow (PCF) measurement (secondary to pharyngeal exposure to aerosolized capsaicin); test person holds transparent hard-plastic cup with capsaicin solution (liquid cayenne extract, containing 1.5–2 s% capsaicin, dissolved in 100 mL carbonated water) 2–5 cm from the patient’s mouth at chin level and stirs the solution gently with a hard-plastic teaspoon
Fig. 3
Fig. 3
Boxplots of voluntary and reflexive peak cough flow (PCF) in patients with neurogenic dysphagia (ND) and healthy controls. The boxplots show the medians and interquartile ranges. The whiskers indicate the lowest and maximum measurements. aDotted lines for cut-off values: PCF > 4.5 L/s = effective clearance; PCF between 4.5 L/s and 2.7 L/s = partly effective clearance; PCF < 2.7 = ineffective clearance [16]
See this image and copyright information in PMC

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