Troche Michelle S, Brandimore Alexandra E, Okun Michael S, Davenport Paul W, Hegland Karen W
From the The Department of Speech, Language, and Hearing Sciences, Malcom Randall VA Medical Center, Gainesville, FL; Center for Movement Disorders and Neurorestoration, University of Florida, Malcom Randall VA Medical Center, Gainesville, FL.
From the The Department of Speech, Language, and Hearing Sciences, Malcom Randall VA Medical Center, Gainesville, FL; Center for Movement Disorders and Neurorestoration, University of Florida, Malcom Randall VA Medical Center, Gainesville, FL; Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, Gainesville, FL.
Chest. 2014 Nov;146(5):1294-1299. doi: 10.1378/chest.14-0066.
Aspiration pneumonia is a leading cause of death in people with Parkinson disease (PD). The pathogenesis of these infections is largely attributed to the presence of dysphagia with silent aspiration or aspiration without an appropriate cough response. The goal of this study was to test reflex cough thresholds and associated urge-to-cough (UTC) ratings in participants with PD with and without dysphagia.
Twenty participants with PD were recruited for this study. They completed a capsaicin challenge with three randomized blocks of 0, 50, 100, and 200 μM capsaicin and rated their UTC by modified Borg scale. The concentration of capsaicin that elicited a two-cough response, total number of coughs, and sensitivity of the participant to the cough stimulus (UTC) were measured. The dysphagia severity of participants with PD was identified with the penetration-aspiration scale.
Most participants with PD did not have a consistent two-cough response to 200 μM capsaicin. UTC ratings and total number of coughs produced at 200 μM capsaicin were significantly influenced by dysphagia severity but not by general PD severity, age, or disease duration. Increasing levels of dysphagia severity resulted in significantly blunted cough sensitivity (UTC).
UTC ratings may be important in understanding the mechanism underlying morbidity related to aspiration pneumonia in people with PD and dysphagia. Further understanding of decreased UTC in people with PD and dysphagia will be essential for the development of strategies and treatments to address airway protection deficits in this population.
吸入性肺炎是帕金森病（PD）患者死亡的主要原因。这些感染的发病机制很大程度上归因于吞咽困难伴无声误吸或误吸时缺乏适当的咳嗽反应。本研究的目的是测试有和没有吞咽困难的PD患者的反射性咳嗽阈值及相关的咳嗽冲动（UTC）评分。
招募了20名PD患者参与本研究。他们完成了辣椒素激发试验，分为三个随机组，分别使用0、50、100和200μM辣椒素，并通过改良的博格量表对其UTC进行评分。测量引发两次咳嗽反应的辣椒素浓度、咳嗽总数以及参与者对咳嗽刺激的敏感性（UTC）。使用渗透 - 误吸量表确定PD患者的吞咽困难严重程度。
大多数PD患者对200μM辣椒素没有一致的两次咳嗽反应。200μM辣椒素时的UTC评分和咳嗽总数受吞咽困难严重程度的显著影响，但不受一般PD严重程度、年龄或病程的影响。吞咽困难严重程度的增加导致咳嗽敏感性（UTC）显著降低。
UTC评分对于理解PD和吞咽困难患者吸入性肺炎相关发病机制可能很重要。进一步了解PD和吞咽困难患者UTC降低的情况对于制定解决该人群气道保护缺陷的策略和治疗方法至关重要。
