title: Sequential voluntary cough and aspiration or aspiration risk in Parkinson's disease.
abstract: BACKGROUND
  Disordered swallowing, or dysphagia, is almost always present to some degree in people with Parkinson's disease (PD), either causing aspiration or greatly increasing the risk for aspiration during swallowing. This likely contributes to aspiration pneumonia, a leading cause of death in this patient population. Effective airway protection is dependent upon multiple behaviors, including cough and swallowing. Single voluntary cough function is disordered in people with PD and dysphagia. However, the appropriate response to aspirate material is more than one cough, or sequential cough. The goal of this study was to examine voluntary sequential coughing in people with PD, with and without dysphagia.
  
  
  METHODS
  Forty adults diagnosed with idiopathic PD produced two trials of sequential voluntary cough. The cough airflows were obtained using pneumotachograph and facemask and subsequently digitized and recorded. All participants received a modified barium swallow study as part of their clinical care, and the worst penetration-aspiration score observed was used to determine whether the patient had dysphagia.
  
  
  RESULTS
  There were significant differences in the compression phase duration, peak expiratory flow rates, and amount of air expired of the sequential cough produced by participants with and without dysphagia.
  
  
  CONCLUSIONS
  The presence of dysphagia in people with PD is associated with disordered cough function. Sequential cough, which is important in removing aspirate material from large- and smaller-diameter airways, is also impaired in people with PD and dysphagia compared with those without dysphagia. There may be common neuroanatomical substrates for cough and swallowing impairment in PD leading to the co-occurrence of these dysfunctions.
authors.affiliation: Department of Speech, Language and Hearing Sciences, University of Florida, 336 Dauer Hall, Gainesville, FL, 32611, USA, kwheeler@ufl.edu.
authors.forename: Karen Wheeler
authors.initials: KW
authors.lastname: Hegland
authors.forename: Michael S
authors.initials: MS
authors.lastname: Okun
authors.forename: Michelle S
authors.initials: MS
authors.lastname: Troche
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003371:Cough / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D003680:Deglutition Disorders / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008168:Lung / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D010366:Peak Expiratory Flow Rate; D011237:Predictive Value of Tests; D053120:Respiratory Aspiration / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D012307:Risk Factors; D014836:Volition