Effect of Capsaicin Atomization on Cough and Swallowing Function in Patients With Hemorrhagic Stroke: A Randomized Controlled Trial

Abstract

Background: Patients with hemorrhagic stroke have high mortality and disability rates. Nevertheless, early rehabilitation interventions can improve their outcomes. We aimed to apply capsaicin atomization as early intervention to patients with hemorrhagic stroke and explore improvements in cough and swallowing functions. Method: Patients with hemorrhagic stroke were randomly divided into the control group, which received routine care, and the intervention group, which underwent the capsaicin solution nebulization scheme in addition to routine care. Differences in the presence/absence of cough reflex and number of coughs in response to capsaicin, the presence/absence of swallowing reflex in response to water, the presence/absence of postswallow residue, substance P (SP) concentration, and pulmonary inflammation between the two groups were determined before and after the intervention. Results: A total of 53 patients with hemorrhagic stroke were included. Results showed no statistically significant difference in cough reflex in both groups after the intervention ( p > .05). The degree of cough in the intervention group was stronger than that in the control group ( p = .046). No statistically significant difference was observed in the number of patients with swallowing reflex in response to water between the groups ( p > .05). The presence/absence of postswallow residue of the intervention group was stronger than that of the control group ( p = .032). No statistically significant difference was observed between the Glasgow Coma Scale scores of the groups after the intervention ( p > .05). SP in the intervention group was significantly increased ( p = .031). The Clinical Pulmonary Infection Score was significantly lower in the control group, and the difference was statistically significant ( p = .028). Conclusions: Capsaicin nebulization can help enhance the number of coughs in response to capsaicin, reduce postswallow residue, and increase the level of SP in patients with hemorrhagic stroke and has a positive effect on pulmonary inflammation. This study provides intervention points for cough and swallowing rehabilitation after a hemorrhagic stroke. Supplemental Material: https://doi.org/10.23641/asha.21956903

Inducing Cough Reflex by Capsaicin Spray Stimulation in Patients with Acquired Brain Injury: A Preliminary Test and Proof of Concept

“…This is coherent with the current literature that described only a skin facial irritation self-limited without the use of drugs [12,[23][24]. Moreover, according to a previous study no alteration of the heart rate, respiratory rate, and oxygen saturation were observed during capsaicin administration [25].…”

“…The test can be used to evaluate the patient's ability to produce an effective cough and to detect any underlying problems with the cough reflex, with a documented excellent safety record in healthy volunteers as well as in patients with asthma, chronic obstructive pulmonary disease, pathologic cough, and other respiratory conditions [13][14]. This test has been applied either for diagnosis of cough reflex deficits or for therapeutic purposes in patients with neurogenic dysphagia [15], progressive supranuclear palsy [16], Parkinson's disease [17], and in patients with hemorrhagic stroke [18].…”

Inducing Cough Reflex by Capsaicin Spray Stimulation in Patients with Acquired Brain Injury: A Preliminary Test and Proof of Concept

“…This is coherent with the current literature that has described only a skin facial irritation that is self-limited without the use of drugs [12,23,24]. Moreover, according to a previous study, no alteration of the heart rate, respiratory rate, or oxygen saturation was observed during capsaicin administration [18].…”

“…The test can be used to evaluate the patient's ability to produce an effective cough and to detect any underlying problems with the cough reflex, with a documented excellent safety record in healthy volunteers as well as in patients with asthma, chronic obstructive pulmonary disease, pathologic cough, and other respiratory conditions [13,14]. This test has been applied either for the diagnosis of cough reflex deficits or for therapeutic purposes in patients with neurogenic dysphagia [15], progressive supranuclear palsy [16], Parkinson's disease [17], and in patients with hemorrhagic stroke [18].…”