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

Abstract

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.

Differences in cough strength, respiratory function, and physical performance in older adults with and without low swallowing function in the repetitive saliva swallowing test

“…Our main finding was that community-dwelling ambulatory older adults with low RSST had lower PCF, MIP, and MEP values than those without low RSST. This is consistent with the finding of reduced PCF in patients with dysphagia, although many of whom had cognitive or physical impairments were from a different population than the participants in this study 20 ) . Similarly, a previous finding that patients with dysphagia had lower PCF and MEP in head and neck cancer survivors 21 ) supports our finding.…”

“…PCF (219 L/min) in the low RSST group was 22% lower than the control group. Reduced PCF (<160 L/min) in older adults with dysphagia and poor functional status significantly increases the risk of aspiration pneumonia 20 ) . In this study, all participants were independent in their daily lives, and participants with neurological disease or airflow limitation were excluded.…”

Metabolic and ventilatory changes during postural change from the supine position to the reclining position in bedridden older patients

“…Moreover, we showed that respiratory function (VC, FVC, and PImax) is associated with peak cough flow (PCF), [22,23] which is used to measure the coughing capacity, and low PCF is associated with the development of pneumonia. [24] Several bedridden older patients, similar to those included in this study, have difficulty in communicating, and measuring their VC, FVC, and PCF is often difficult. Future analyses of the relationship among V T , PCF, and pneumonia in the appropriate reclining wheelchair sitting position may yield the development of programs that can help prevent pneumonia in bedridden older patients.…”

Deterioration of Cough, Respiratory, and Vocal Cord Functions in Patients with Multiple System Atrophy

“…Participants were instructed to cough after maximal deep inspiration. PCF assessment was performed 3 times, and the highest value was used for analysis [ 18 ].…”