title: The value of cough peak flow in the assessment of cough efficacy in neuromuscular patients. A cross sectional study.
abstract: BACKGROUND
  Cough efficacy assessment is of clinical relevance in neuromuscular patients. Tests of varying complexity and invasiveness, such as cough peak flow (CPF), maximal expiratory pressure (PEmax) and gastric pressure during cough (Cough Pgas) are routinely available.
  
  
  OBJECTIVE
  To assess the value of CPF, PEmax and Cough Pgas in the detection of ineffective cough in patients suffering from neuromuscular diseases.
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  Outpatient laboratory for respiratory muscle function assessment.
  
  
  METHODS
  Forty-nine patients with neuromuscular diseases (25 F, age 50 ± 15 years).
  
  
  METHODS
  Each patient performed spirometry, CPF, PEmax, Cough Pgas and maximal inspiratory pressure (PImax). Normal values for each test were determined from published and in-house lab data.
  
  
  RESULTS
  In all patients, vital capacity ranged from 46 to 119% of pred. Twenty seven percent of patients resulted under the lower normal limit of CPF and this percentage was significantly lower as compared to that of PEmax and Cough Pgas (51% and 53% respectively, P=0.013). Combining all three tests, the percentage of patients resulting below normal was 22% (P=0.638, as compared to CPF results alone). Additionally, CPF correlated significantly with PImax, PEmax, and Cough Pgas (P<0.01 for each correlation) and by multiple regression analysis PImax and PEmax contributed 65% of CPF variance.
  
  
  CONCLUSIONS
  Our study shows that in neuromuscular patients, PEmax and Cough Pgas values may overdiagnose an ineffective cough. CPF, a non invasive and easy to perform test, is a global measure of voluntary cough. CLINICAL REHABILITATION SETTING:CPF may be relevant in the routine evaluation of patients with neuromuscular diseases, both in research and in rehabilitation settings.
authors: Department of Clinical and Experimental Medicine Lung Function and Respiratory Disease Units University Hospital of Parma, Parma, Italy - panayotat@yahoo.com.
authors: P
authors: P
authors: Tzani
authors: S
authors: S
authors: Chiesa
authors: M
authors: M
authors: Aiello
authors: A
authors: A
authors: Scarascia
authors: C
authors: C
authors: Catellani
authors: D
authors: D
authors: Elia
authors: E
authors: E
authors: Marangio
authors: A
authors: A
authors: Chetta
mesh_terms: D000328:Adult; D003371:Cough / Q000209:etiology / Q000503:physiopathology*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009468:Neuromuscular Diseases / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology*; D010366:Peak Expiratory Flow Rate / Q000502:physiology*; D011446:Prospective Studies; D012132:Respiratory Muscles / Q000503:physiopathology*; D014797:Vital Capacity / Q000502:physiology*