Department of Physiological Sciences, Movement Disorders Center, Malcom Randall Veterans Administration Medical Center, Gainesville, FL 32610-0144, USA.
Chest. 2010 Dec;138(6):1426-31. doi: 10.1378/chest.10-0342. Epub 2010 Aug 12.
Identification of people with Parkinson disease (PD) who are at risk for aspiration is important, especially because of the high prevalence of aspiration pneumonia.
Fifty-eight consecutive patients (Hoehn and Yahr stage II-III; average age 72.3) were enrolled in the study. Measures of airflow during voluntary cough production and the degree of penetration/aspiration on a 3-oz oropharyngeal swallow task, derived from videofluorographic images, were examined.
To detect at-risk people (those with penetration and/or aspiration on the 3-oz swallow task), four objective measures of voluntary cough (compression phase duration [CPD], expiratory phase rise time [EPRT], expiratory phase peak flow [EPPF], and cough volume acceleration [CVA)]) were collected. CPD, EPRT, EPPF, and CVA measurements produced significant area under the curve (AUC) analyses and likelihood ratios equal to 0.83:2.72, 0.71:2.68, 0.69:1.75, and 0.78:18.42, respectively. CPD, EPRT, EPPF, and CVA measurements demonstrated sensitivities of 95.83%, 70.83%, 87.50%, and 84.53%, and specificities of 64.71%, 73.53%, 50.01%, and 97.06%, respectively. For detection of aspiration, EPPF was significantly associated with an AUC = 0.88 and with an EPPF < 5.24, which had a sensitivity of 57.15% and a specificity of 100%.
The data from this pilot study suggest that in patients with PD, objective airflow measures from voluntary cough production may identify at-risk penetrator/aspirators. To our knowledge, this is the first study to evaluate the discriminative ability of voluntary cough airflow characteristics to model airway compromise in people with PD.
识别有发生吸入风险的帕金森病（PD）患者很重要，尤其是因为吸入性肺炎的高发率。
本研究纳入了 58 例连续患者（Hoehn 和 Yahr 分期 II-III；平均年龄 72.3 岁）。通过视频荧光透视图像检查了自愿咳嗽产生时的气流以及在 3 盎司口咽吞咽任务中的渗透/吸入程度的测量值。
为了检测有风险的人群（在 3 盎司吞咽任务中存在渗透和/或吸入的人群），收集了四项自愿咳嗽的客观测量值（压缩相持续时间[CPD]、呼气相上升时间[EPRT]、呼气相峰值流量[EPPF]和咳嗽体积加速度[CVA]）。CPD、EPRT、EPPF 和 CVA 测量值的曲线下面积（AUC）分析和似然比分别为 0.83:2.72、0.71:2.68、0.69:1.75 和 0.78:18.42。CPD、EPRT、EPPF 和 CVA 测量值的敏感性分别为 95.83%、70.83%、87.50%和 84.53%，特异性分别为 64.71%、73.53%、50.01%和 97.06%。对于吸入的检测，EPPF 与 AUC=0.88 显著相关，且 EPPF<5.24 时，其敏感性为 57.15%，特异性为 100%。
这项初步研究的数据表明，在 PD 患者中，自愿咳嗽产生时的客观气流测量值可能可以识别有风险的渗透/吸入者。据我们所知，这是第一项评估自愿咳嗽气流特征的区分能力以模拟 PD 患者气道损伤的研究。
