title: Voluntary Cough Airflow Differentiates Safe Versus Unsafe Swallowing in Amyotrophic Lateral Sclerosis.
abstract: Dysphagia and aspiration are prevalent in amyotrophic lateral sclerosis (ALS) and contribute to malnutrition, aspiration pneumonia, and death. Early detection of at risk individuals is critical to ensure maintenance of safe oral intake and optimal pulmonary function. We therefore aimed to determine the discriminant ability of voluntary cough airflow measures in detecting penetration/aspiration status in ALS patients. Seventy individuals with ALS (El-Escorial criteria) completed voluntary cough spirometry testing and underwent a standardized videofluoroscopic swallowing evaluation (VFSE). A rater blinded to aspiration status derived six objective measures of voluntary cough airflow and evaluated airway safety using the penetration-aspiration scale (PAS). A between groups ANOVA (safe vs. unsafe swallowers) was conducted and sensitivity, specificity, area under the curve (AUC) and likelihood ratios were calculated. VFSE analysis revealed 24 penetrator/aspirators (PAS ≥3) and 46 non-penetrator/aspirators (PAS ≤2). Cough volume acceleration (CVA), peak expiratory flow rise time (PEFRT), and peak expiratory flow rate (PEFR) were significantly different between airway safety groups (p < 0.05) and demonstrated significant discriminant ability to detect the presence of penetration/aspiration with AUC values of: 0.85, 0.81, and 0.78, respectively. CVA <45.28 L/s/s, PEFR <3.97 L/s, and PEFRT >76 ms had sensitivities of 91.3, 82.6, and 73.9 %, respectively, and specificities of 82.2, 73.9, and 78.3 % for identifying ALS penetrator/aspirators. Voluntary cough airflow measures identified ALS patients at risk for penetration/aspiration and may be a valuable screening tool with high clinical utility.
authors.affiliation: Department of Speech, Language and Hearing Sciences, University of Florida, PO Box 117420, Gainesville, FL, 32611, USA. eplowman@phhp.ufl.edu.|Neuromotor Speech and Swallowing Restoration Laboratory, University of Florida, Gainesville, USA. eplowman@phhp.ufl.edu.
authors.forename: Emily K
authors.initials: EK
authors.lastname: Plowman
authors.affiliation: Neuromotor Speech and Swallowing Restoration Laboratory, University of Florida, Gainesville, USA.|Joy McCann Center for Swallowing Disorders, University of South Florida, Tampa, USA.
authors.forename: Stephanie A
authors.initials: SA
authors.lastname: Watts
authors.affiliation: Department of Speech, Language and Hearing Sciences, University of Florida, PO Box 117420, Gainesville, FL, 32611, USA.|Neuromotor Speech and Swallowing Restoration Laboratory, University of Florida, Gainesville, USA.
authors.forename: Raele
authors.initials: R
authors.lastname: Robison
authors.affiliation: Department of Speech, Language and Hearing Sciences, University of Florida, PO Box 117420, Gainesville, FL, 32611, USA.|Neuromotor Speech and Swallowing Restoration Laboratory, University of Florida, Gainesville, USA.
authors.forename: Lauren
authors.initials: L
authors.lastname: Tabor
authors.affiliation: Joy McCann Center for Swallowing Disorders, University of South Florida, Tampa, USA.
authors.forename: Charles
authors.initials: C
authors.lastname: Dion
authors.affiliation: Joy McCann Center for Swallowing Disorders, University of South Florida, Tampa, USA.
authors.forename: Joy
authors.initials: J
authors.lastname: Gaziano
authors.affiliation: Department of Neurology, University of South Florida, Tampa, USA.
authors.forename: Tuan
authors.initials: T
authors.lastname: Vu
authors.affiliation: Department of Neurology, University of South Florida, Tampa, USA.
authors.forename: Clifton
authors.initials: C
authors.lastname: Gooch
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000690:Amyotrophic Lateral Sclerosis / Q000150:complications / Q000503:physiopathology*; D019540:Area Under Curve; D003371:Cough; D003679:Deglutition / Q000502:physiology*; D003680:Deglutition Disorders / Q000175:diagnosis* / Q000503:physiopathology; D005260:Female; D005471:Fluoroscopy / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D012119:Respiration; D053120:Respiratory Aspiration / Q000175:diagnosis* / Q000503:physiopathology; D012680:Sensitivity and Specificity; D013147:Spirometry / Q000379:methods; D055815:Young Adult
keywords: Amyotrophic lateral sclerosis; Aspiration; Cough; Deglutition; Deglutition disorders; Screen