A Primer on Hypotussic Cough: Mechanisms and Assessment

Lowell, Emilie R.; Borders, James C; Sevitz, Jordanna S; Dakin, Avery E; Brates, Danielle; Troche, Michelle S.

doi:10.1007/s40136-023-00446-5

Cited by 5 publications

(17 citation statements)

References 107 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Perceived strength, duration, strain, coordination, effectiveness, normality, type of expiratory maneuver, and number of expiratory maneuvers were included because they are either currently used in clinical practice [18][19][20][21][22] and have preliminary evidence suggesting important relationships with objective measures of cough airflow [43,49]. Furthermore, research has found that perceptual ratings of cough strength and effectiveness can predict "safe" versus "unsafe" swallowers [49] -findings which have been repeatedly seen when evaluating people with dysphagia using objective methods to assess cough airflow [9]. "Amount of voicing" was included since voicing is an established component of the acoustic cough phase and has physiologic relevance [17].…”

Section: Discussionmentioning

confidence: 99%

“…It is an important airway protective behavior intended to clear penetrant and aspirate material out of the airway in order to maintain a healthy and homeostatic pulmonary environment [3]. Disordered coughing (dystussia) is characterized by reductions in cough airflow, expiratory pressures, and blunted sensorimotor responses [4][5][6][7][8][9] and, when present, is associated with an increased risk of pneumonia [10][11][12][13][14][15].…”

Section: Cough and Dysphagiamentioning

confidence: 99%

See 1 more Smart Citation

Auditory-Perceptual Assessments of Cough: Characterizing Rater Reliability and the Effects of a Standardized Training Protocol

Curtis,

Borders,

Dakin

et al. 2023

Folia Phoniatr Logop

View full text Add to dashboard Cite

Introduction: Auditory-perceptual assessments of cough are commonly used by speech-language pathologists working with people with swallowing disorders with emerging evidence beginning to demonstrate their validity, however their reliability amongst novice clinicians is unknown. Therefore, the primary aim of this study was to characterize the reliability of auditory-perceptual assessments of cough amongst a group of novice clinicians. As a secondary aim, we assessed the effects of a standardized training protocol on the reliability of auditory-perceptual assessments of cough. Methods: 12 novice clinicians blindly rated ten auditory-perceptual cough descriptors for 120 cough audio clips. Standardized training was then completed by the group of clinicians. The same cough audio clips were then re-randomized and blindly rated. Reliability was analyzed pre- and post-training within each clinician (intra-rater), between each unique pair of raters (dyad-level inter-rater), and for the entire group of raters (group-level inter-rater) using intraclass correlation coefficients and Cohen’s Kappa. Results: Pre-training reliability was greatest for measures of strength, effectiveness, and normality, and lowest when judging the type of expiratory maneuver (cough, throat clear, huff, other). The measures that improved the most with training were ratings of perceived crispness, amount of voicing, and type of expiratory maneuver. Intra-rater reliability coefficients ranged from .580-.903 pre-training and .756-.904 post-training. Dyad-level inter-rater reliability coefficients ranged from .295-.745 pre-training and .450-.804 post-training. Group-level inter-rater reliability coefficients ranged from .454-.919 pre-training and .558-.948 post-training. Discussion/Conclusion: Reliability of auditory-perceptual assessments varied across perceptual cough descriptors, but all appeared within the range of what has been historically reported for auditory-perceptual assessments of voice and visual-perceptual assessments of swallowing and cough airflow. Reliability improved for most cough descriptors following 30-60 minutes of standardized training. Future research is needed to examine the validity of auditory-perceptual assessments of cough by assessing the relationship between perceptual cough descriptors with instrumental measures of cough effectiveness to better understand the role of perceptual assessments in clinical practice.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Cough and Dysphagiamentioning

confidence: 99%

Auditory-Perceptual Assessments of Cough: Characterizing Rater Reliability and the Effects of a Standardized Training Protocol

Curtis,

Borders,

Dakin

et al. 2023

Folia Phoniatr Logop

View full text Add to dashboard Cite

show abstract

“…It is primarily associated with cough hyposensitivity and/or reduced cough effectiveness ( 2 , 8 – 11 ). The reduced cough effectiveness observed in hypotussia ( 12 ) is characterized by distinct impairments in cough motor airflow patterns [ Figure 1 , Supplementary File S1 : Lowell et al ( 2 ), McGarvey et al ( 12 )]. One of the main clinical outcome measures and indicators of uncompensated aspiration is peak cough flow or peak expiratory flow rate (hereafter, referred to as PEFR) ( 21 – 23 ).…”

Section: Introductionmentioning

confidence: 99%

“…Hypotussia may occur due to underlying afferent and efferent deficits in the neural control of cough [ Figure 2 . Pathophysiology of hypotussia, please see Supplementary File S1 : Lowell et al ( 2 ), for a detailed neurological review]. In individuals with dysphagia, hypotussia is concerning as it results in an inability to adequately sense or move aspirate material from the airways ( 2 , 15 , 16 ).…”

Section: Introductionmentioning

confidence: 99%

Hypotussic cough in persons with dysphagia: biobehavioral interventions and pathways to clinical implementation

Dallal-York,

Troche

2024

Front. Rehabil. Sci.

Self Cite

View full text Add to dashboard Cite

Cough is a powerful, protective expulsive behavior that assists in maintaining respiratory health by clearing foreign material, pathogens, and mucus from the airways. Therefore, cough is critical to survival in both health and disease. Importantly, cough protects the airways and lungs from both antegrade (e.g., food, liquid, saliva) and retrograde (e.g., bile, gastric acid) aspirate contents. Aspiration is often the result of impaired swallowing (dysphagia), which allows oral and/or gastric contents to enter the lung, especially in individuals who also have cough dysfunction (dystussia). Cough hyposensitivity, downregulation, or desensitization- collectively referred to as hypotussia- is common in individuals with dysphagia, and increases the likelihood that aspirated material will reach the lung. The consequence of hypotussia with reduced airway clearance can include respiratory tract infection, chronic inflammation, and long-term damage to the lung parenchyma. Despite the clear implications for health, the problem of managing hypotussia in individuals with dysphagia is frequently overlooked. Here, we provide an overview of the current interventions and treatment approaches for hypotussic cough. We synthesize the available literature to summarize research findings that advance our understanding of these interventions, as well as current gaps in knowledge. Further, we highlight pragmatic resources to increase awareness of hypotussic cough interventions and provide support for the clinical implementation of evidence-based treatments. In culmination, we discuss potential innovations and future directions for hypotussic cough research.

show abstract

“…An effective cough typically involves three distinct phases: inspiration, compression, and forceful expiration. Spirometry is the gold-standard approach to quantify cough airflow across these phases and outcomes related to the velocity, volume, and timing of airflow events can be measured (for a full review see Lowell et al 2023). Since the respiratory system is closely linked with cough production, researchers may also measure movements of the rib cage and abdomen with respiratory inductive plethysmography to derive estimates of lung volume (for a detailed description see McKenna and Huber 2019).…”

Section: Introductionmentioning

confidence: 99%

Semi-Automated Measurement of Cough Airflow and Lung Volume: A Tutorial

Borders¹

2023

Preprint

View full text Add to dashboard Cite

The production of a cough involves three distinct phases: inspiration, compression, and forceful expiration. Various cough and lung volume outcomes can be derived from these phases with spirometry or respiratory inductive plethysmography methodologies, respectively. However, current research best-practice requires the user to laboriously measure each outcome in isolation with a graphical user interface. This approach introduces measurement error, potentially impacting reliability and validity. In this tutorial, we present a semi-automated approach to measure cough and lung volume outcomes. Instead of requiring the user to measure each outcome in isolation, time stamps are recorded for nine different cough or respiratory events. An automated program then uses these time stamps to derive relevant cough and respiratory outcomes. In our experience, this approach has reduced the analysis of files with upwards of 45 distinct cough trials from 1-2 hours to 30-45 minutes for a trained rater. Additionally, this workflow provides a verifiable approach to resolve discrepancies, increasing data analysis transparency and reproducibility. This open source tutorial provides a hands-on introduction to this semi-automated workflow, as well as a thorough description of the automated calculations in the R programming language with the hope that other researchers will integrate this workflow to streamline and improve cough measurement.

show abstract

A Primer on Hypotussic Cough: Mechanisms and Assessment

Cited by 5 publications

References 107 publications

Auditory-Perceptual Assessments of Cough: Characterizing Rater Reliability and the Effects of a Standardized Training Protocol

Auditory-Perceptual Assessments of Cough: Characterizing Rater Reliability and the Effects of a Standardized Training Protocol

Hypotussic cough in persons with dysphagia: biobehavioral interventions and pathways to clinical implementation

Semi-Automated Measurement of Cough Airflow and Lung Volume: A Tutorial

Contact Info

Product

Resources

About