title: Using voluntary cough to detect penetration and aspiration during oropharyngeal swallowing in patients with Parkinson disease.
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.
authors: Department of Physiological Sciences, Movement Disorders Center, Malcom Randall Veterans Administration Medical Center, Gainesville, FL 32610-0144, USA. tepitts@ufl.edu
authors: Teresa
authors: T
authors: Pitts
authors: Michelle
authors: M
authors: Troche
authors: Giselle
authors: G
authors: Mann
authors: John
authors: J
authors: Rosenbek
authors: Michael S
authors: MS
authors: Okun
authors: Christine
authors: C
authors: Sapienza
mesh_terms: 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