title: Measurement of Voluntary Cough Production and Airway Protection in Parkinson Disease.
abstract: OBJECTIVE
  To examine relations between peak expiratory (cough) airflow rate and swallowing symptom severity in participants with Parkinson disease (PD).
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  Outpatient radiology clinic at an acute care hospital.
  
  
  METHODS
  Men and women with PD (N=68).
  
  
  METHODS
  Participants were cued to cough into an analog peak flow meter then swallowed three 20-mL thin liquid barium boluses. Analyses were directed at detecting potential relations among disease severity, swallowing symptom severity, and peak expiratory (cough) airflow rate.
  
  
  METHODS
  Peak expiratory (cough) airflow rate and swallow symptom severity.
  
  
  RESULTS
  Peak expiratory (cough) airflow rate varied significantly across swallowing severity classifications. Participants with more severe disease displayed a significant, linear decrease in peak expiratory (cough) airflow rate than those participants with earlier stage, less severe disease. Swallowing symptom severity varied significantly across groups when comparing participants with less severe PD with those with more severe PD. Participants with early stage PD demonstrated little to no swallowing symptoms and had the highest measures of peak expiratory (cough) airflow rate. In contrast, participants with the most severe swallowing symptoms also displayed the lowest measures of peak expiratory (cough) airflow rate.
  
  
  CONCLUSIONS
  Relations existed among PD severity, swallowing symptom severity, and peak expiratory (cough) airflow rate in participants with PD. Peak expiratory (cough) airflow rate may eventually stand as a noninvasive predictor of aspiration risk in those with PD, particularly those with later stage disease. Inclusion of peak expiratory (cough) airflow rates into existing clinical swallowing assessments may increase the sensitivity and predictive validity of these assessments.
authors.affiliation: Department of Physiological Sciences, University of Florida, Gainesville, FL. Electronic address: epearson@ufl.edu.
authors.forename: Erin P
authors.initials: EP
authors.lastname: Silverman
authors.affiliation: Department of Communication Sciences and Disorders, University of Central Florida, Orlando, FL.
authors.forename: Giselle
authors.initials: G
authors.lastname: Carnaby
authors.affiliation: Brooks Rehabilitation, Jacksonville, FL; Department of Communication Sciences and Disorders, Jacksonville University, Jacksonville, FL.
authors.forename: Floris
authors.initials: F
authors.lastname: Singletary
authors.affiliation: Department of Communication Sciences and Disorders, University of Central Florida, Orlando, FL.
authors.forename: Bari
authors.initials: B
authors.lastname: Hoffman-Ruddy
authors.affiliation: Eastman Chemical Company, Kingsport, TN.
authors.forename: James
authors.initials: J
authors.lastname: Yeager
authors.affiliation: Brooks Rehabilitation, Jacksonville, FL; Department of Communication Sciences and Disorders, Jacksonville University, Jacksonville, FL.
authors.forename: Christine
authors.initials: C
authors.lastname: Sapienza
mesh_terms: D000368:Aged; D003371:Cough / Q000503:physiopathology*; D003430:Cross-Sectional Studies; D003680:Deglutition Disorders / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000503:physiopathology*; D010366:Peak Expiratory Flow Rate; D012129:Respiratory Function Tests; D012720:Severity of Illness Index
keywords: Airway management; Cough; Parkinson disease; Rehabilitation; Respiratory aspiration