Using voluntary cough to detect penetration and aspiration during oropharyngeal swallowing in patients with Parkinson disease.
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.
Pitts
Teresa
T
Department of Physiological Sciences, Movement Disorders Center, Malcom Randall Veterans Administration Medical Center, Gainesville, FL 32610-0144, USA. tepitts@ufl.edu
Troche
Michelle
M
Mann
Giselle
G
Rosenbek
John
J
Okun
Michael S
MS
Sapienza
Christine
C
D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003371:Cough; D003679:Deglutition / Q000502:physiology; D003680:Deglutition Disorders / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D005471:Fluoroscopy / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D009960:Oropharynx / Q000502:physiology; D010300:Parkinson Disease / Q000150:complications* / Q000175:diagnosis*; D011015:Pneumonia, Aspiration / Q000209:etiology / Q000517:prevention & control*; D011237:Predictive Value of Tests; D011379:Prognosis; D012372:ROC Curve; D012720:Severity of Illness Index; D014741:Video Recording