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Clinical Investigations: AIRWAYS |

Daily Oral Care and Cough Reflex Sensitivity in Elderly Nursing Home Patients*

Aya Watando, MD; Satoru Ebihara, MD, PhD; Takae Ebihara, MD, PhD; Tatsuma Okazaki, MD, PhD; Hidenori Takahashi, MD, PhD; Masanori Asada, MD; Hidetada Sasaki, MD, PhD, FCCP
Author and Funding Information

*From the Department of Geriatric and Respiratory Medicine, Tohoku University School of Medicine, Sendai, Japan.

Correspondence to: Hidetada Sasaki, MD, PhD, FCCP, Department of Geriatric and Respiratory Medicine, Tohoku University School of Medicine, Seiryo-machi 1–1, Aoba-ku, Sendai 980-8574, Japan; e-mail: dept@geriat.med.tohoku.ac.jp



Chest. 2004;126(4):1066-1070. doi:10.1378/chest.126.4.1066
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Background: Intensive oral care can reduce the incidence of pneumonia in elderly nursing home patients, but the mechanism is unknown.

Objective: To explore the effects of intensive oral care on impaired cough reflex sensitivity, which is a known risk factor of aspiration pneumonia.

Methods: Cough reflex sensitivity to citric acid was measured in elderly nursing home patients, who were randomly assigned to the intervention group (n = 30) and the control group (n = 29). The patients in the intervention group had their teeth and gingiva cleaned by caregivers after every meal for 1 month. The patients in the control group performed their own oral care during the same period. Serum substance P (SP) concentration, cognitive function, and activities of daily living (ADL) were also assessed.

Results: In the intervention group, cough reflex sensitivity at 30 days showed significantly higher sensitivity than baseline (p < 0.01). At 30 days, the cough reflex sensitivities in the intervention group were significantly higher than that of the control group (p < 0.05). Compared with the control group, the odds ratio of improvement of cough reflex sensitivity was 5.3 (95% confidence interval, 1.7 to 16.0; p < 0.005) for the intervention group. One month of intensive oral care did not have a significant effect on serum SP concentration, cognitive function, and ADL.

Conclusion: Intensive oral care may reduce the incidence of pneumonia by improving cough reflex sensitivity in elderly nursing home patients.

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