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Original Research: Signs and Symptoms of Chest Diseases |

Concordance and Discriminatory Power of Cough Measurement Devices for Individuals With Parkinson DiseaseConcordance Discriminatory Power of Cough Devices

Erin P. Silverman, PhD; Giselle Carnaby-Mann, PhD; Teresa Pitts, PhD; Paul Davenport, PhD; Michael S. Okun, MD; Christine Sapienza, PhD
Author and Funding Information

From the Brain Rehabilitation and Research Center (Drs Silverman and Sapienza), Malcom Randall VA Medical Center, Gainesville; Department of Physiological Sciences (Drs Silverman, Pitts, and Davenport), College of Veterinary Medicine, Department of Behavioral Science and Community Health (Dr Carnaby-Mann), College of Public Health and Health Professions, and Departments of Neurology and Neurosurgery (Dr Okun), Center for Movements Disorders and Neurorestoration, College of Medicine, University of Florida, Gainesville; and Department of Communication Sciences and Disorders, College of Health Sciences (Dr Sapienza), Jacksonville University, Jacksonville, FL.

Correspondence to: Erin P. Silverman, PhD, Department of Physiological Sciences, College of Veterinary Medicine, University of Florida, PO Box 100144, Gainesville, FL 32611; e-mail: epearson@ufl.edu


Funding/Support: This study was supported by the National Institutes of Health, National Institute on Deafness and Other Communication Disorders [Grants R21/R33 and 7R33DC011131-04].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;145(5):1089-1096. doi:10.1378/chest.13-0596
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Background:  Dysphagia and aspiration pneumonia are two causes of morbidity in Parkinson disease (PD). In PD, impaired airway clearance can lead to penetration of foreign material, resulting in a high prevalence of aspiration pneumonia and death. This study examines three different devices for measurement of peak airflow during voluntary cough in healthy control subjects and those with PD. Two simple and low-cost devices for measuring peak cough airflow were compared with the “gold standard” pneumotachograph.

Methods:  Thirty-five healthy control subjects and 35 individuals with PD produced voluntary cough at three perceived strengths (weak, moderate, and strong cough) for each of the three devices.

Results:  A significant difference in mean peak cough airflow was demonstrated for disease (F[1,56] = 4.0, P < .05) and sex (F[1,56] = 9.59, P < .003) across devices. The digital and analog meters were comparable to the gold standard demonstrating no significant difference (statistical) by device (digital vs analog) in receiver operating characteristic curve analysis. Both devices were discriminative of the presence of PD.

Conclusions:  The analog and digital peak airflow meters are suitable alternatives to the gold standard pneumotachograph due to their low cost, portability, ease of use, and high sensitivity relative to normative peak cough airflows. Voluntary cough airflow measures may serve as a noninvasive means of screening for aspiration risk in target populations. Additionally, quantification of cough strength through use of predetermined limens for weak, moderate, and strong cough may assist clinicians in better describing and tracking cough strength as a contributing factor to aspiration risk.

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