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Original Research: COUGH |

Using Voluntary Cough To Detect Penetration and Aspiration During Oropharyngeal Swallowing in Patients With Parkinson Disease

Teresa Pitts, PhD; Michelle Troche, PhD; Giselle Mann, PhD; John Rosenbek, PhD; Michael S. Okun, MD; Christine Sapienza, PhD
Author and Funding Information

From the Department of Physiological Sciences (Dr Pitts), the Movement Disorders Center (Drs Pitts, Troche, Rosenbek, Okun, and Sapienza), the Department of Speech, Language, and Hearing Sciences (Drs Troche, Rosenbek, and Sapienza), the Department of Behavioral Sciences and Community Health (Dr Mann), and the Department of Neurology (Dr Okun), University of Florida; and the Brain Rehabilitation Research Center (Drs Pitts, Troche, Rosenbek, and Sapienza), Malcom Randall Veterans Administration Medical Center, Gainesville, FL.

Correspondence to: Teresa Pitts, PhD, PO Box 100144, Gainesville, FL 32610-0144; e-mail: tepitts@ufl.edu


Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2010 American College of Chest Physicians


Chest. 2010;138(6):1426-1431. doi:10.1378/chest.10-0342
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Background:  Identification of people with Parkinson disease (PD) who are at risk for aspiration is important, especially because of the high prevalence of aspiration pneumonia.

Methods:  Fifty-eight consecutive patients (Hoehn and Yahr stage II-III; average age 72.3) were enrolled in the study. Measures of airflow during voluntary cough production and the degree of penetration/aspiration on a 3-oz oropharyngeal swallow task, derived from videofluorographic images, were examined.

Results:  To detect at-risk people (those with penetration and/or aspiration on the 3-oz swallow task), four objective measures of voluntary cough (compression phase duration [CPD], expiratory phase rise time [EPRT], expiratory phase peak flow [EPPF], and cough volume acceleration [CVA)]) were collected. CPD, EPRT, EPPF, and CVA measurements produced significant area under the curve (AUC) analyses and likelihood ratios equal to 0.83:2.72, 0.71:2.68, 0.69:1.75, and 0.78:18.42, respectively. CPD, EPRT, EPPF, and CVA measurements demonstrated sensitivities of 95.83%, 70.83%, 87.50%, and 84.53%, and specificities of 64.71%, 73.53%, 50.01%, and 97.06%, respectively. For detection of aspiration, EPPF was significantly associated with an AUC = 0.88 and with an EPPF < 5.24, which had a sensitivity of 57.15% and a specificity of 100%.

Conclusions:  The data from this pilot study suggest that in patients with PD, objective airflow measures from voluntary cough production may identify at-risk penetrator/aspirators. To our knowledge, this is the first study to evaluate the discriminative ability of voluntary cough airflow characteristics to model airway compromise in people with PD.

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