Voluntary Cough Airflow Differentiates Safe Versus Unsafe Swallowing in Amyotrophic Lateral Sclerosis
| Autor: | Tuan Vu, Emily K. Plowman, Clifton L. Gooch, Joy Gaziano, Stephanie A. Watts, Raele Robison, Charles Dion, Lauren Tabor |
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| Rok vydání: | 2015 |
| Předmět: |
Adult
Male medicine.medical_specialty Aspiration pneumonia Sensitivity and Specificity Article Pulmonary function testing 03 medical and health sciences Speech and Hearing Young Adult 0302 clinical medicine Swallowing medicine Humans Amyotrophic lateral sclerosis Aged Aged 80 and over business.industry Respiration Amyotrophic Lateral Sclerosis Gastroenterology Area under the curve Respiratory Aspiration Middle Aged medicine.disease Dysphagia respiratory tract diseases Deglutition 030228 respiratory system Otorhinolaryngology Cough Spirometry Anesthesia Area Under Curve Fluoroscopy Physical therapy Female medicine.symptom business Airway Deglutition Disorders 030217 neurology & neurosurgery |
| Zdroj: | Dysphagia. 31(3) |
| ISSN: | 1432-0460 |
| Popis: | Dysphagia and aspiration are prevalent in amyotrophic lateral sclerosis (ALS) and contribute to malnutrition, aspiration pneumonia and death. Early detection of at risk individuals is critical to ensure maintenance of safe oral intake and optimal pulmonary function. We therefore aimed to determine the discriminant ability of voluntary cough airflow measures in detecting penetration/aspiration status in ALS patients. Seventy individuals with ALS (El-Escorial criteria) completed voluntary cough spirometry testing and underwent a standardized videofluoroscopic swallowing evaluation (VFSE). A rater blinded to aspiration status derived six objective measures of voluntary cough airflow and evaluated airway safety using the Penetration Aspiration Scale (PAS). A between groups ANOVA (safe vs. unsafe swallowers) was conducted and sensitivity, specificity, area under the curve (AUC) and likelihood ratios were calculated. VFSE analysis revealed 24 penetrator/aspirators (PAS ≥3) and 46 non-penetrator/aspirators (PAS ≤2). Cough volume acceleration (CVA), peak expiratory flow rise time (PEFRT), and peak expiratory flow rate (PEFR) were significantly different between airway safety groups (p 76ms had sensitivities of 91.3%, 82.6% and 73.9% respectively and specificities of 82.2%, 73.9%, and 78.3% for identifying ALS penetrator/aspirators. Voluntary cough airflow measures identified ALS patients at risk for penetration/aspiration and may be a valuable screening tool with high clinical utility. |
| Databáze: | OpenAIRE |
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