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. 2016 Mar;97(3):413-20.
doi: 10.1016/j.apmr.2015.10.098. Epub 2015 Nov 6.

Measurement of Voluntary Cough Production and Airway Protection in Parkinson Disease

Erin P Silverman  1 , Giselle Carnaby  2 , Floris Singletary  3 , Bari Hoffman-Ruddy  2 , James Yeager  4 , Christine Sapienza  3
Affiliations

Measurement of Voluntary Cough Production and Airway Protection in Parkinson Disease

Erin P Silverman et al. Arch Phys Med Rehabil. 2016 Mar.

Abstract

Objective: To examine relations between peak expiratory (cough) airflow rate and swallowing symptom severity in participants with Parkinson disease (PD).

Design: Cross-sectional study.

Setting: Outpatient radiology clinic at an acute care hospital.

Participants: Men and women with PD (N=68).

Interventions: Participants were cued to cough into an analog peak flow meter then swallowed three 20-mL thin liquid barium boluses. Analyses were directed at detecting potential relations among disease severity, swallowing symptom severity, and peak expiratory (cough) airflow rate.

Main outcome measures: Peak expiratory (cough) airflow rate and swallow symptom severity.

Results: Peak expiratory (cough) airflow rate varied significantly across swallowing severity classifications. Participants with more severe disease displayed a significant, linear decrease in peak expiratory (cough) airflow rate than those participants with earlier stage, less severe disease. Swallowing symptom severity varied significantly across groups when comparing participants with less severe PD with those with more severe PD. Participants with early stage PD demonstrated little to no swallowing symptoms and had the highest measures of peak expiratory (cough) airflow rate. In contrast, participants with the most severe swallowing symptoms also displayed the lowest measures of peak expiratory (cough) airflow rate.

Conclusions: Relations existed among PD severity, swallowing symptom severity, and peak expiratory (cough) airflow rate in participants with PD. Peak expiratory (cough) airflow rate may eventually stand as a noninvasive predictor of aspiration risk in those with PD, particularly those with later stage disease. Inclusion of peak expiratory (cough) airflow rates into existing clinical swallowing assessments may increase the sensitivity and predictive validity of these assessments.

Keywords: Airway management; Cough; Parkinson disease; Rehabilitation; Respiratory aspiration.

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Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Mini Wright Analog Peak Flow Meter www.miniwrightpeakflowmeters.com
Figure 2
Figure 2
Mean PEFR in early (H&Y 1–2) and later stage (H&Y 3+) participants with PD.
Figure 3
Figure 3
Main effects for PEFR as a function of age, gender and disease severity.
Figure 4
Figure 4
PEFR measures obtained from early stage (H&Y 1–2) and later stage (H&Y 3+) participants with PD compared to HCs.
Figure 5
Figure 5
Cough strength (PEFR) as a function of swallow severity (PAS) in participants with PD.
Figure 6
Figure 6
Swallow severity (PAS) as a function of disease severity (H&Y) in participants with PD.
See this image and copyright information in PMC

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