Abstract-This review presents the available evidence for the effects of expiratory muscle strength training (EMST) with the use of a pressure threshold device. The investigators used computerized database searches for studies reporting the outcomes of pressure threshold EMST published after 1994. A total of 24 selected articles presented outcomes related but not limited to respiratory function, such as speech, swallow, voice, and cough function in persons with neurologic conditions such as Parkinson disease, multiple sclerosis, and Lance-Adams syndrome; in persons with respiratory diseases, such as chronic obstructive pulmonary disease; and in healthy young adults and sedentary and active elderly. Several studies demonstrated promising outcomes of EMST as a non-task-specific training for airway protection in persons with dysphagia secondary to neuromuscular impairments; however, further research is needed to confirm and generalize the reported findings.

This study examined the relationships between subjective descriptors and objective airflow measures of cough. We hypothesized that coughs with specific airflow characteristics would share common subjective perceptual descriptions. Thirty clinicians (speech-language pathologists, otolaryngologists, and neurologists) perceptually evaluated ten cough audio samples with specific airflow characteristics determined by peak expiratory flow rate, cough expired volume, cough duration, and number of coughs in the cough epoch. Participants rated coughs by strength, duration, quality, quantity, and overall potential effectiveness for airway protection. Perception of cough strength and effectiveness was determined by the combination of presence of pre-expulsive compression phase, short peak expiratory airflow rate rise time, high peak expiratory flow rates, and high cough volume acceleration. Perception of cough abnormality was defined predominantly by descriptors of breathiness and strain. Breathiness was characteristic for coughs with either absent compression phases and relatively high expiratory airflow rates or coughs with significantly low expired volumes and reduced peak flow rates. In contrast, excessive strain was associated with prolonged compression phases and low expiratory airflow rates or the absence of compression phase with high peak expiratory rates. The study participants reached greatest agreement in distinguishing between single and multiple coughs. Their assessment of cough strength and effectiveness was less consistent. Finally, the least agreement was shown in determining the quality categories. Modifications of cough airflow can influence perceptual cough evaluation outcomes. However, the inconsistency of cough ratings among our participants suggests that a uniform cough rating system is required.

Expiratory muscle strength training (EMST) is a rehabilitative program that has been tested for outcomes related to respiratory muscle strength, cough, swallow, and voice function in healthy young adult, elderly individuals, and in patients with progressive neurodegenerative disease. Because EMST has been used in patient care, the associated cardiovascular responses during EMST are of importance. This study investigated the changes in systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), and oxygen saturation (SpO2) during one session of EMST in healthy, young adults as a preliminary study of device safety. Thirty-one participants completed a single session of 25 trials with the EMST device. Valsalva maneuvers were performed at the beginning and at the end of the EMST trials for task comparison. The SBP, DBP, HR, and SpO2 were recorded at the baseline and after completing the following tasks: a Valsalva maneuver, 12 trials using the EMST device, 13 trials using the EMST device, and 5 min of rest following the EMST session. A mixed linear model tested for changes across the six time points. The results indicated no significant change of SBP, DBP, HR, or SpO2 during or following the EMST trials or after performing the Valsalva maneuver. The results suggest that EMST does not elicit significant fluctuations of blood pressure, HR, and SpO2 in healthy young adults even when considering the effects of covariates on the outcomes measures.