0
Correspondence |

Response FREE TO VIEW

Carol Smith Hammond, PhD; Donald Bolser, PhD; Larry Goldstein, MD; Leslie Gonzales-Rothi, PhD
Author and Funding Information

Affiliations: Audiology and Speech, Durham VAMC Department of Medicine Duke University Durham, NC,  Physiological Sciences University of Florida Gainesville, FL,  Department of Medicine Duke University Durham, NC,  VA Brain Rehabilitation Research Center, Gainesville VAMC Gainesville, FL

Carol Smith Hammond, PhD, Durham VAMC, 508 Fulton St, No. 126, Durham, NC 27705; e-mail: smith390@mc.duke.edu


The authors have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

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


© 2009 American College of Chest Physicians


Chest. 2009;136(2):648. doi:10.1378/chest.09-0901
Text Size: A A A
Published online

To the Editor:

We appreciate Professors Widdicombe and Addington's comments regarding our study of aspiration risk in stroke patients1 but disagree with their assertion that “subjective measurement of voluntary cough has not been shown to give less acceptable results than the objective method.” McCullough et al2 found that although the specificity of subjective bedside assessments of voluntary cough ranged from 79 to 89%, sensitivity was poor, ranging from 26 to 42%. This indicates that, if used alone, subjective assessment of voluntary cough would miscategorize at least half of the patients at increased aspiration risk. Our results show that objective assessment of voluntary cough has sensitivities and specificities in excess of 90% in predicting patients at risk of aspiration, and this represents an improved accuracy over standard subjective measures. These findings indicate that objective measures of voluntary cough may be useful to screen stroke patients for the need for further evaluation of swallow function by a speech language pathologist.1 Therefore, the higher sensitivity and specificity of objective analysis of voluntary cough when compared to a traditional bedside assessment (including evaluation of reflexive cough) for the identification of aspiration risk is clinically important. The necessary equipment needed for voluntary cough testing is readily available and easy to use. The test can be completed quickly and is safe (ie, it does not require patients to risk aspiration by attempting to swallow any material).

We do not dispute that other measures of airway protection may also be clinically useful and agree that additional studies evaluating airway protection are needed. Further studies of this nature will help to refine screening tools and spur the development of novel interventions to reduce the stroke patient's risk of aspiration.

Smith Hammond CA, Goldstein LB, Horner RD, et al. Predicting aspiration in patients with ischemic stroke: comparison of clinical signs and aerodynamic measures of voluntary cough. Chest. 2009;135:769-777. [PubMed] [CrossRef]
 
McCullough GH, Rosenbek JC, Wertz RT, et al. Utility of clinical swallowing examination measures for detecting aspiration post-stroke. J Speech Lang Hear Res. 2005;48:1280-1293. [PubMed]
 

Figures

Tables

References

Smith Hammond CA, Goldstein LB, Horner RD, et al. Predicting aspiration in patients with ischemic stroke: comparison of clinical signs and aerodynamic measures of voluntary cough. Chest. 2009;135:769-777. [PubMed] [CrossRef]
 
McCullough GH, Rosenbek JC, Wertz RT, et al. Utility of clinical swallowing examination measures for detecting aspiration post-stroke. J Speech Lang Hear Res. 2005;48:1280-1293. [PubMed]
 
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543