title: Cough reflex attenuation and swallowing dysfunction in sub-acute post-stroke patients: prevalence, risk factors, and clinical outcome.
abstract: BACKGROUND
  Cough and swallowing impairments in post-stroke patients (PSP) have been associated with increased risk for respiratory complications.
  
  
  OBJECTIVE
  To assess the prevalence of alterations in protective cough responses in subacute PSP and its association with oropharyngeal dysphagia (OD), clinical, and neurotopographic stroke factors and clinical outcomes.
  
  
  METHODS
  Three months after stroke, the cough reflex test (CRT) was performed by nebulizing incremental citric acid concentrations (7.8-1000 mmol L-1) to determine the concentration that elicited two and five coughs; OD was assessed by the volume-viscosity swallow test. Clinical and neurotopographic stroke risk factors and complications (readmissions, respiratory infections, institutionalization, and mortality) were recorded from 3 to 12 months post-stroke.
  
  
  RESULTS
  We included 225 PSP. Prevalence of impaired CRT was 5.8%, that of OD was 40.4% (20.4% with impaired safety of swallow), and of both impairments was, 1.8%. No specific risk factors associated with impaired CRT were found; however, hemorrhagic, wide circulation infarction (TACI), and brainstem strokes delayed the cough response. OD was associated with age, TACI and poor functional and nutritional status. Outcome of PSPs was unaffected by impaired CRT but OD and impaired safety of swallow increased institutionalization, respiratory infections, and mortality with the poorest outcome for those with both impairments.
  
  
  CONCLUSIONS
  Prevalence of subacute post-stroke OD and swallow safety impairments was much higher than CRT attenuation, and risk factors strongly differed suggesting that the swallow response receives a stronger cortical control than the cough reflex. OD has a greater impact on PSP clinical outcome than impaired cough, the poorest prognosis being for patients with both airway protective dysfunctions.
authors.affiliation: Unitat d'Exploracions Funcionals Digestives, Department of Surgery, Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Spain.
authors.forename: N
authors.initials: N
authors.lastname: Vilardell
authors.affiliation: Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Barcelona, Spain.
authors.forename: L
authors.initials: L
authors.lastname: Rofes
authors.affiliation: Medical School of Ribeirão Preto, University of São Paulo, São Paulo, Brazil.
authors.forename: W V
authors.initials: WV
authors.lastname: Nascimento
authors.affiliation: Neurology Unit, Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Spain.
authors.forename: D
authors.initials: D
authors.lastname: Muriana
authors.affiliation: Neurology Unit, Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Palomeras
authors.affiliation: Unitat d'Exploracions Funcionals Digestives, Department of Surgery, Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Spain.|Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Barcelona, Spain.|Fundació Institut d'Investigació en Ciències de la Salut, Germans Trias i Pujol, Badalona, Spain.
authors.forename: P
authors.initials: P
authors.lastname: Clavé
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003371:Cough / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology*; D003679:Deglutition / Q000502:physiology; D003680:Deglutition Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology*; D016896:Treatment Outcome
keywords: aspiration pneumonia; citric acid; cough; deglutition; deglutition disorders; stroke