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Original Research: Signs and Symptoms of Chest Diseases |

Decreased Cough Sensitivity and Aspiration in Parkinson DiseaseDecreased Cough Sensitivity and Parkinson Disease

Michelle S. Troche, PhD, CCC-SLP; Alexandra E. Brandimore, MA, CCC-SLP; Michael S. Okun, MD; Paul W. Davenport, PhD; Karen W. Hegland, PhD, CCC-SLP
Author and Funding Information

From the Department of Speech, Language, and Hearing Sciences (Drs Troche and Hegland and Ms Brandimore), Department of Neurology (Dr Okun), Department of Physiological Sciences (Dr Davenport), and Center for Movement Disorders and Neurorestoration (Drs Troche, Okun, Davenport, and Hegland and Ms Brandimore), University of Florida; and Brain Rehabilitation Research Center (Ms Brandimore), Malcom Randall VA Medical Center, Gainesville, FL.

CORRESPONDENCE TO: Michelle S. Troche, PhD, CCC-SLP, University of Florida, PO Box 117420, Gainesville, FL 32611; e-mail: michi81@phhp.ufl.edu


Part of this article has been presented in abstract form at the Annual Meeting of the International Society for the Advancement of Respiratory Psychophysiology, September 27-29, 2013, Leuven, Belgium.

FUNDING/SUPPORT: This work was funded in part by a National Institutes of Health (National Center for Advancing Translational Sciences) Clinical and Translational Science Award through the University of Florida [UL1TR000064 and KL2TR000065 to Dr Troche].

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


Chest. 2014;146(5):1294-1299. doi:10.1378/chest.14-0066
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BACKGROUND:  Aspiration pneumonia is a leading cause of death in people with Parkinson disease (PD). The pathogenesis of these infections is largely attributed to the presence of dysphagia with silent aspiration or aspiration without an appropriate cough response. The goal of this study was to test reflex cough thresholds and associated urge-to-cough (UTC) ratings in participants with PD with and without dysphagia.

METHODS:  Twenty participants with PD were recruited for this study. They completed a capsaicin challenge with three randomized blocks of 0, 50, 100, and 200 μM capsaicin and rated their UTC by modified Borg scale. The concentration of capsaicin that elicited a two-cough response, total number of coughs, and sensitivity of the participant to the cough stimulus (UTC) were measured. The dysphagia severity of participants with PD was identified with the penetration-aspiration scale.

RESULTS:  Most participants with PD did not have a consistent two-cough response to 200 μM capsaicin. UTC ratings and total number of coughs produced at 200 μM capsaicin were significantly influenced by dysphagia severity but not by general PD severity, age, or disease duration. Increasing levels of dysphagia severity resulted in significantly blunted cough sensitivity (UTC).

CONCLUSIONS:  UTC ratings may be important in understanding the mechanism underlying morbidity related to aspiration pneumonia in people with PD and dysphagia. Further understanding of decreased UTC in people with PD and dysphagia will be essential for the development of strategies and treatments to address airway protection deficits in this population.

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