title: Cough efficacy is related to the disability status in patients with multiple sclerosis.
abstract: BACKGROUND
  Cough is an important defense mechanism, whose main function is to remove mucus and/or foreign bodies from the airways. In patients with multiple sclerosis (MS), respiratory muscle function may be affected and cough may be impaired.
  
  
  OBJECTIVE
  Respiratory muscle strength and voluntary cough efficacy were determined in MS patients and controls, and the relationship between cough efficacy and patients' degree of disability was investigated.
  
  
  METHODS
  We recruited 27 MS patients (age: 41 +/- 11 years; 18 females) with mild-to-moderate disability, Expanded Disability Status Scale (EDSS) score range: 1-7, and 20 healthy controls (age: 37 +/- 11 years; 12 females). The maximal inspiratory (PIMAX) and expiratory (PEMAX) pressures, maximal whistle mouth pressures (PMOW), cough peak flows (CPF), cough expiratory volumes (CEV) and cough gastric pressures (PGA) were measured in all subjects.
  
  
  RESULTS
  In MS patients, the EDSS score was significantly related to CPF, PEMAX, PMOW, cough PGA, PIMAX and CEV (p < 0.01, each correlation). The receiver-operating characteristic curve showed that an EDSS score > or =5.5 was consistent with impaired cough (CPF < or =5.6 l/s), with a sensitivity of 0.85 and a specificity of 0.95 (area under curve 0.90, p < 0.001). CPF was related to and predicted by PEMAX, PMOW, cough PGA and PIMAX in MS patients (p < 0.01 each correlation), but not in controls.
  
  
  CONCLUSIONS
  MS can affect voluntary cough efficacy and respiratory muscle strength, which are inversely related to the patients' degree of disability. In addition, this study shows that CPF is a measure of clinical relevance in MS patients.
authors.affiliation: Department of Clinical Sciences, University of Parma, Parma, Italy. marina.aiello@unipr.it
authors.forename: Marina
authors.initials: M
authors.lastname: Aiello
authors.forename: Anais
authors.initials: A
authors.lastname: Rampello
authors.forename: Franco
authors.initials: F
authors.lastname: Granella
authors.forename: Matteo
authors.initials: M
authors.lastname: Maestrelli
authors.forename: Panagiota
authors.initials: P
authors.lastname: Tzani
authors.forename: Paolo
authors.initials: P
authors.lastname: Immovilli
authors.forename: Marco
authors.initials: M
authors.lastname: Franceschini
authors.forename: Dario
authors.initials: D
authors.lastname: Olivieri
authors.forename: Alfredo
authors.initials: A
authors.lastname: Chetta
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D003371:Cough / Q000503:physiopathology*; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008176:Lung Volume Measurements; D008297:Male; D009103:Multiple Sclerosis / Q000503:physiopathology*; D053580:Muscle Strength / Q000502:physiology; D012132:Respiratory Muscles / Q000503:physiopathology; D012680:Sensitivity and Specificity