Voluntary Cough Production and Swallow Dysfunction in Parkinson’s Disease

Abstract

Cough is important for airway clearance, particularly if penetration/aspiration of foreign material occurs during swallow. Measures of voluntary cough production from ten male participants with stage II-III Parkinson's disease (PD) who showed no videofluorographic evidence of penetration/aspiration (Group 1) were examined and compared with those of ten male participants with stage II-III PD who showed videofluorographic evidence of penetration/aspiration (Group 2). The degree of penetration/aspiration was expertly judged from the videofluorographic examinations of the participants' sequential swallow of a thin, 30-cc bolus. Measured cough parameters included inspiratory phase duration, inspiratory peak flow, compression phase duration, expiratory peak flow, expiratory rise time, and cough volume acceleration. Results indicated significant group differences for the majority of cough measures, except for inspiratory phase duration and inspiratory peak flow. A modest relationship existed between voluntary cough parameters and penetration/aspiration scores. Decreased ability to adequately clear material from the airway with voluntary cough may exacerbate symptoms resulting from penetration/aspiration, particularly for those with neurodegenerative disease. Measurement of voluntary cough may be useful for the evaluation of airway clearance ability.

Differences in the Peak Cough Flow among Stroke Patients With and Without Dysphagia

“…Patients with Parkinsonʼs disease also show a decreased capacity for voluntary cough and a swallowing disturbance from the early stages [12]. Pitts, et al described that the decreased ability to adequately clear material from the airway with a voluntary cough may exacerbate symptoms resulting from airway penetration in patients with Parkinsonʼs disease [13]. Ebihara, et al measured the PCF of patients with Parkinsonʼs disease, and reported that it was 230 ± 74 l/min in the early stage and 186±60 l/min in the advanced stage [14].…”

Associations Between Laryngeal and Cough Dysfunction in Motor Neuron Disease with Bulbar Involvement

“…Dystussia is related to risk for aspiration and respiratory failure in people with neuromuscular dysfunction. [3][4][5][6][7][8] It is well known that dystussia can occur due to weakness of the inspiratory and/or expiratory respiratory muscles. 2 In particular, weakness of the abdominal muscles results in difficulty generating sufficient pressure for a forceful, effective cough.…”

“…Pitts and colleagues also reported correlations between EPRT and VA and aspiration as measured via videofluoroscopic swallow studies in individuals with Parkinson's disease. 8 They concluded that volitional cough ability may be associated with the degree of airway protection. 8 It is unclear if similar findings will be observed in individuals with MND.…”

“…8 They concluded that volitional cough ability may be associated with the degree of airway protection. 8 It is unclear if similar findings will be observed in individuals with MND.…”

“…Abnormal EPRT and/or VA measures may also indicate a higher risk of aspiration. 3,8 Further research will be needed to verify this in the MND population.…”