Karen Wheeler Hegland1, Michelle S Troche2, Alexandra E Brandimore2, Paul W Davenport3, Michael S Okun4. 1. Department of Speech Language and Hearing Sciences, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA; Center for Movement Disorders and Neurorestoration, College of Medicine, University of Florida, Gainesville, FL, USA. Electronic address: kwheeler@ufl.edu. 2. Department of Speech Language and Hearing Sciences, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA; Center for Movement Disorders and Neurorestoration, College of Medicine, University of Florida, Gainesville, FL, USA. 3. Department of Physiological Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL, USA. 4. Center for Movement Disorders and Neurorestoration, College of Medicine, University of Florida, Gainesville, FL, USA; Department of Neurology, College of Medicine, University of Florida, Gainesville, FL, USA.
Abstract
INTRODUCTION: Multiple airway protective mechanisms are impacted with Parkinson's disease (PD), including swallowing and cough. Cough serves to eject material from the lower airways, and can be produced voluntarily (on command) and reflexively in response to aspirate material or other airway irritants. Voluntary cough effectiveness is reduced in PD however it is not known whether reflex cough is affected as well. The goal of this study was to compare the effectiveness between voluntary and reflex cough in patients with idiopathic PD. METHODS: Twenty patients with idiopathic PD participated. Cough airflow data were recorded via facemask in line with a pneumotachograph. A side delivery port connected the nebulizer for delivery of capsaicin, which was used to induce cough. Three voluntary coughs and three reflex coughs were analyzed from each participant. A two-way repeated measures analysis of variance was used to compare voluntary versus reflex cough airflow parameters. RESULTS: Significant differences were found for peak expiratory flow rate (PEFR) and cough expired volume (CEV) between voluntary and reflex cough. Specifically, both PEFR and CEV were reduced for reflex as compared to voluntary cough. CONCLUSION: Cough PEFR and CEV are indicative of cough effectiveness in terms of the ability to remove material from the lower airways. Differences between these two cough types likely reflect differences in the coordination of the respiratory and laryngeal subsystems. Clinicians should be aware that evaluation of cough function using voluntary cough tasks overestimates the PEFR and CEV that would be achieved during reflex cough in patients with PD.
INTRODUCTION: Multiple airway protective mechanisms are impacted with Parkinson's disease (PD), including swallowing and cough. Cough serves to eject material from the lower airways, and can be produced voluntarily (on command) and reflexively in response to aspirate material or other airway irritants. Voluntary cough effectiveness is reduced in PD however it is not known whether reflex cough is affected as well. The goal of this study was to compare the effectiveness between voluntary and reflex cough in patients with idiopathic PD. METHODS: Twenty patients with idiopathic PD participated. Cough airflow data were recorded via facemask in line with a pneumotachograph. A side delivery port connected the nebulizer for delivery of capsaicin, which was used to induce cough. Three voluntary coughs and three reflex coughs were analyzed from each participant. A two-way repeated measures analysis of variance was used to compare voluntary versus reflex cough airflow parameters. RESULTS: Significant differences were found for peak expiratory flow rate (PEFR) and cough expired volume (CEV) between voluntary and reflex cough. Specifically, both PEFR and CEV were reduced for reflex as compared to voluntary cough. CONCLUSION:Cough PEFR and CEV are indicative of cough effectiveness in terms of the ability to remove material from the lower airways. Differences between these two cough types likely reflect differences in the coordination of the respiratory and laryngeal subsystems. Clinicians should be aware that evaluation of cough function using voluntary cough tasks overestimates the PEFR and CEV that would be achieved during reflex cough in patients with PD.
Authors: Sang Chul Lee; Seong-Woong Kang; Min Tae Kim; Yong Kyun Kim; Won Hyuk Chang; Sang Hee Im Journal: Arch Phys Med Rehabil Date: 2012-11-12 Impact factor: 3.966
Authors: Michelle S Troche; Beate Schumann; Alexandra E Brandimore; Michael S Okun; Karen W Hegland Journal: Dysphagia Date: 2016-07-26 Impact factor: 3.438
Authors: Carolyn K Novaleski; Richard L Doty; Alissa A Nolden; Paul M Wise; Joel D Mainland; Pamela H Dalton Journal: J Voice Date: 2021-01-14 Impact factor: 2.300
Authors: Erin Silverman; Christine M Sapienza; Sarah Miller; Giselle Carnaby; Charles Levy; Hsiu-Wen Tsai; Paul W Davenport Journal: Can Respir J Date: 2016-09-27 Impact factor: 2.409
Authors: Kai K Lee; Paul W Davenport; Jaclyn A Smith; Richard S Irwin; Lorcan McGarvey; Stuart B Mazzone; Surinder S Birring Journal: Chest Date: 2020-09-02 Impact factor: 9.410