Cough Strength Is an Indicator of Aspiration Risk When Restarting Food Intake in Elderly Subjects With Community-Acquired Pneumonia

Sakai, Yasunari; Ohira, Masayoshi; Yokokawa, Yoshiharu

doi:10.4187/respcare.07067

Cited by 14 publications

(12 citation statements)

References 30 publications

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“…Hammond et al [8] conducted a research in patients with ischemic stroke to predict the aspiration risk using voluntary cough, and this was associated with an aspiration risk with a cut-off value of <2.9 L/s (=174 L/ min). Sakai et al [15] also suggested in their study that PCF could be used as an indicator to evaluate the aspiration risk in older adults with pneumonia, and the cut-off Pearson chi-square test. www.e-arm.org value was 190 L/min.…”

Section: Discussionmentioning

confidence: 99%

Peak Voluntary Cough Flow and Oropharyngeal Dysphagia as Risk Factors for Pneumonia

et al. 2021

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Objective To investigate the relationship between voluntary peak cough flow (PCF), oropharyngeal dysphagia, and pneumonia in patients who were evaluated with videofluoroscopic swallowing study (VFSS).Methods Patients who underwent both VFSS and PCF measurement on the same day were enrolled retrospectively (n=821). Pneumonia (n=138) and control (n=683) groups were assigned based on presence of pneumonia within 1 month from the date of VFSS assessment. In addition, sex, age (<65 and ≥65 years), preceding conditions, modified Barthel Index (MBI), Mini-Mental State Examination (MMSE), PCF value (<160, ≥160 and <270, and ≥270 L/min), and presence of aspiration/penetration on VFSS were reviewed.Results Pneumonia group was more likely to be male (n=108; 78.3%), ≥65 years (n=121; 87.7%), with neurodegenerative (n=25; 18.1%) or other miscellaneous diseases (n=50; 36.2%), and in poor functional level with lower value of MBI (39.1±26.59). However, MMSE was not significantly different in comparison to that of the control group. The pneumonia group was also more likely to have dysphagia (82.6%) and lower value of PCF (<160 L/min, 70.3%). In multivariable logistic regression analysis, male sex (odd ratio [OR]=6.62; 95% confidence interval [CI], 2.70–16.26), other miscellaneous diseases as preceding conditions (OR=2.52; 95% CI, 1.14–5.58), dysphagia (OR=3.82; 95% CI, 1.42–10.23), and PCF <160 L/min (OR=14.34; 95% CI, 1.84–111.60) were factors significantly related with pneumonia.Conclusion Impaired swallowing and coughing function showed an independent association with the development of pneumonia. Patients with PCF <160 L/min require more attention with lung care and should be encouraged with voluntary coughing strategy to prevent possible pulmonary complications.

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Section: Discussionmentioning

confidence: 99%

Peak Voluntary Cough Flow and Oropharyngeal Dysphagia as Risk Factors for Pneumonia

et al. 2021

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“…Cut-off values below 79 L/min predict respiratory complications with high accuracy [ 17 ]. In addition, cough strength, assessed by PCF, can be used to determine the aspiration risk when restarting food intake in elderly subjects with aspiration pneumonia [ 18 ]. In our second case, while the PCF level was below the suggested cut-off value in the initial assessment, the value increased in parallel with the mean peak RMS values by the time the patient was allowed to commence oral feeding.…”

Section: Discussionmentioning

confidence: 99%

Cough Sounds Recorded via Smart Devices as Useful Non-Invasive Digital Biomarkers of Aspiration Risk: A Case Report

Kang

Lee

Cheol-Ki

et al. 2021

Sensors

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Spirometer measurements can reflect cough strength but might not be routinely available for patients with severe neurological or medical conditions. A digital device that can record and help track abnormal cough sound changes serially in a noninvasive but reliable manner would be beneficial for monitoring such individuals. This report includes two cases of respiratory distress whose cough changes were monitored via assessments performed using recordings made with a digital device. The cough sounds were recorded using an iPad (Apple, Cupertino, CA, USA) through an embedded microphone. Cough sounds were recorded at the bedside, with no additional special equipment. The two patients were able to complete the recordings with no complications. The maximum root mean square values obtained from the cough sounds were significantly reduced when both cases were diagnosed with aspiration pneumonia. In contrast, higher values became apparent when the patients demonstrated a less severe status. Based on an analysis of our two cases, the patients’ cough sounds recorded with a commercial digital device show promise as potential digital biomarkers that may reflect aspiration risk related to attenuated cough force. Serial monitoring aided the decision making to resume oral feeding. Future studies should further explore the clinical utility of this technique.

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“…Swallowing function was evaluated using the repetitive saliva swallowing test (RSST), which showed sensitivity and specificity of 70.0% and 71.7%, respectively, in predicting aspiration [18]. A single trained dentist (S.A.) performed the RSST.…”

Section: Swallowing Functionmentioning

confidence: 99%

“…A swallow was counted only when the thyroid cartilage rose past the middle finger sufficiently. If such swallows were noted three consecutive times, the swallowing function was considered normal [18].…”

Section: Swallowing Functionmentioning

confidence: 99%

Trypsin-Like Activity in Oral Cavity Is Associated with Risk of Fever Onset in Older Residents of Nursing Homes: An 8-Month Longitudinal Prospective Cohort Pilot Study

Izumi

Isobe

Akifusa

2021

IJERPH

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This study aimed to evaluate the association between trypsin-like activity in the oral cavity and the onset of fever in independent older residents of nursing homes. Independent older residents aged ≥ 65 years in 10 nursing homes were included in this study, which was conducted in Kitakyushu, Japan. For 8 months, follow-up dates on which the body temperatures of participants were more than 37.2 °C were noted. Trypsin-like activity in the oral cavity was detected by ADCHECK® with five-grade evaluation at baseline. Data from 53 independent participants with median age 89.0 (67–102) years were available for analysis. ADCHECK® scores were associated with fever days (r = 0.312, p = 0.029). The average periods until the onset of fever in participants with ADCHECK® Scores 1 and 2, Score 3, and Scores 4 and 5 were 6.6 ± 0.5, 5.0 ± 0.7, and 4.1 ± 1.0 months, respectively. ADCHECK® Scores 4 and 5 signified a higher risk of fever compared to ADCHECK® Scores 1 and 2 (hazards ratio 9.8, 95% confidence interval 1.5–65.7, p = 0.034), adjusted for possible confounders. We concluded that trypsin-like activity in the oral cavity was associated with the risk of fever in independent older residents of nursing homes.

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Cough Strength Is an Indicator of Aspiration Risk When Restarting Food Intake in Elderly Subjects With Community-Acquired Pneumonia

Cited by 14 publications

References 30 publications

Peak Voluntary Cough Flow and Oropharyngeal Dysphagia as Risk Factors for Pneumonia

Peak Voluntary Cough Flow and Oropharyngeal Dysphagia as Risk Factors for Pneumonia

Cough Sounds Recorded via Smart Devices as Useful Non-Invasive Digital Biomarkers of Aspiration Risk: A Case Report

Trypsin-Like Activity in Oral Cavity Is Associated with Risk of Fever Onset in Older Residents of Nursing Homes: An 8-Month Longitudinal Prospective Cohort Pilot Study

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