title: Cough peak flow as a predictor of pulmonary morbidity in patients with dysphagia.
abstract: OBJECTIVE
  The aim of this study was to ascertain whether an objective cough measure relates to the risk of pulmonary complications in dysphagic patients with persistent tracheobronchial aspiration.
  
  
  METHODS
  This is a retrospective observational study involving 55 dysphagic patients who underwent a modified barium swallow study and pulmonary function tests including cough peak flow measurement. The results were compared between subjects with and without pulmonary complications because of aspiration.
  
  
  RESULTS
  The 18 patients (33%) with pulmonary complications had significantly lower mean cough peak flow values (202.2 ± 68.8 vs. 303.9 ± 80.7 liters/min; P < 0.001) than those without pulmonary complications. The finding of tracheobronchial coating in a modified barium swallow was not related to the occurrence of pulmonary morbidity. Receiver operating characteristic curve analysis showed that a CPF level lower than 242 liters/min predicted the development of pulmonary complications with a sensitivity of 77% and a specificity of 83%; the positive and negative predictive values were 65% and 90%, respectively.
  
  
  CONCLUSIONS
  Our findings indicate that cough peak flow is a valuable predictor of respiratory prognosis in chronic aspiration. This finding suggests a new rehabilitation strategy aimed at improving cough flows for dysphagic patients.
authors.affiliation: Rehabilitation Unit, Fondazione Don Carlo Gnocchi, Centro IRCCS Santa Maria Nascente, Milan. Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Bianchi
authors.forename: Paola
authors.initials: P
authors.lastname: Baiardi
authors.forename: Sonia
authors.initials: S
authors.lastname: Khirani
authors.forename: Giovanna
authors.initials: G
authors.lastname: Cantarella
mesh_terms: D000368:Aged; D002908:Chronic Disease; D003371:Cough / Q000145:classification / Q000209:etiology* / Q000503:physiopathology* / Q000517:prevention & control; D003680:Deglutition Disorders / Q000150:complications* / Q000534:rehabilitation*; D005260:Female; D006801:Humans; D008171:Lung Diseases / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D012372:ROC Curve; D053120:Respiratory Aspiration / Q000209:etiology / Q000503:physiopathology; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity