Curtis James A, Troche Michelle S
Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, 10027, USA.
Dysphagia. 2020 Dec;35(6):993-1000. doi: 10.1007/s00455-020-10097-z. Epub 2020 Feb 24.
Aspiration pneumonia is a leading cause of death in Parkinson's disease (PD), occurring as a result of impaired cough and swallowing function. However, portable diagnostic tools for cough assessment and dysphagia screening are limited. Therefore, the aims of this study were to determine if: (1) 'Handheld Cough Testing' (HCT), a novel tool developed for cough assessments, could detect differences in cough airflow and sensation during reflex and voluntary cough tasks; and (2) HCT could screen for dysphagia in PD with high sensitivity. Twenty-two people with PD underwent HCT and swallowing assessments. Cough airflow ('PEFR') and sensation ('UTC') was recorded during reflex and voluntary cough tasks. Flexible endoscopy was used to identify people with and without dysphagia. Within-subject statistical analyses were used to detect differences in PEFR and UTC across cough tasks and between-subject statistical analyses were used to detect differences in cough function between people with and without dysphagia. Results revealed significant differences in PEFR (p < 0.0005) and UTC (p < 0.0005) across cough tasks using HCT. Additionally, reflex cough PEFR was significantly different between people with and without dysphagia (p < 0.05). A cut-off of 42.5 L/min exhibited an excellent ability to predict dysphagia in people with PD (90.9% sensitivity; 80.0% specificity). This study revealed that HCT was a valid tool for cough assessment and dysphagia screening. It identified differences in cough airflow and sensation during reflex and voluntary cough tasks and screened for people with dysphagia in PD with high sensitivity.
吸入性肺炎是帕金森病（PD）患者死亡的主要原因之一，是由咳嗽和吞咽功能受损所致。然而，用于咳嗽评估和吞咽困难筛查的便携式诊断工具有限。因此，本研究的目的是确定：（1）“手持式咳嗽测试”（HCT）这一用于咳嗽评估的新型工具，能否检测出反射性咳嗽任务和自主咳嗽任务期间咳嗽气流及感觉的差异；（2）HCT能否以高灵敏度筛查PD患者的吞咽困难。22名PD患者接受了HCT和吞咽评估。在反射性咳嗽任务和自主咳嗽任务期间记录咳嗽气流（“呼气峰流速”）和感觉（“咳嗽阈值”）。使用软性内镜检查来确定有无吞咽困难的患者。采用受试者内统计分析来检测不同咳嗽任务中呼气峰流速和咳嗽阈值的差异，采用受试者间统计分析来检测有无吞咽困难患者之间咳嗽功能的差异。结果显示，使用HCT时，不同咳嗽任务中的呼气峰流速（p<0.0005）和咳嗽阈值（p<0.0005）存在显著差异。此外，有无吞咽困难患者之间的反射性咳嗽呼气峰流速存在显著差异（p<0.05）。以42.5升/分钟为临界值时，预测PD患者吞咽困难的能力极佳（灵敏度为90.9%；特异度为80.0%）。本研究表明，HCT是一种用于咳嗽评估和吞咽困难筛查的有效工具。它能识别反射性咳嗽任务和自主咳嗽任务期间咳嗽气流及感觉的差异，并能以高灵敏度筛查PD患者中的吞咽困难患者。
