A prospective examination of swallow and cough dysfunction after lung transplantation

Abstract

Objectives: Swallow and cough dysfunction are possible surgical complications of lung transplantation (LT). We examined voluntary cough strength, sensorimotor reflexive cough integrity, and swallow-related respiratory rate (RR) across swallowing safety and aspiration response groups in recovering LT recipients.Methods: Forty-five LT recipients underwent flexible endoscopic evaluation of swallowing indexed by the validated Penetration Aspiration Scale. RR before and after a 3-ounce water drinking task was measured. Voluntary and reflexive cough screening were performed to index motor and sensory outcomes. T-tests, one-way ANOVAs, and chi-square (odds ratios) were used.Results: 60% of patients exhibited laryngeal penetration (n = 27) and 40% demonstrated tracheal aspiration (n = 18); 72% (n = 13) demonstrated silent aspiration.

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

“…Peripheral airway clearance techniques are secretion mobilizing and aim to loosen secretions to improve ventilation ( 57 , 115 ). Secretion mobilization is achieved by increasing expiratory flow above inspiratory, referred to as “bias expiratory flow”, to move secretions from the distal to proximal airways, where they can then be cleared with a cough or evacuated with respiratory equipment ( 52 , 115 ). Peripheral airway clearance can be achieved through manual techniques, chest wall oscillation or compression, percussive ventilation and/or chest wall strapping ( 56 , 57 , 110 , 113 ).…”

“…Further, dysphagia-related hypotussia is associated with increased rates of pneumonia, reintubation, hospital readmission, and costs of care ( 31 , 34 – 38 ). Complex deficits across the continuum of airway protection (i.e., swallow to cough) co-occur in multiple patient populations including: Parkinson's disease ( 39 , 40 ), amyotrophic lateral sclerosis [ALS; ( 23 , 41 – 43 )], multiple sclerosis ( 44 ), atypical parkinsonism ( 31 ), progressive supranuclear palsy [PSP, ( 45 )], cerebellar ataxia ( 25 ), stroke ( 41 , 46 ), head and neck cancer ( 47 – 49 ), cerebral palsy ( 50 ), spinal cord injury ( 51 ), lung transplantation ( 52 ), and cardiac surgery ( 37 ). Thus, to improve health and quality of life for this large and heterogeneous group of patients, it is critical that rehabilitation efforts include cough ( 4 , 15 , 31 , 38 ).…”

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“…Peripheral airway clearance techniques are secretion mobilizing and aim to loosen secretions to improve ventilation (57,115). Secretion mobilization is achieved by increasing expiratory flow above inspiratory, referred to as "bias expiratory flow", to move secretions from the distal to proximal airways, where they can then be cleared with a cough or evacuated with respiratory equipment (52,115). Peripheral airway clearance can be achieved through manual techniques, chest wall oscillation or compression, percussive ventilation and/or chest wall strapping (56, 57,110,113).…”

“…Further, dysphagia-related hypotussia is associated with increased rates of pneumonia, reintubation, hospital readmission, and costs of care (31,(34)(35)(36)(37)(38). Complex deficits across the continuum of airway protection (i.e., swallow to cough) co-occur in multiple patient populations including: Parkinson's disease (39, 40), amyotrophic lateral sclerosis [ALS; (23,(41)(42)(43)], multiple sclerosis (44), atypical parkinsonism (31), progressive supranuclear palsy [PSP, (45)], cerebellar ataxia (25), stroke (41,46), head and neck cancer (47)(48)(49), cerebral palsy (50), spinal cord injury (51), lung transplantation (52), and cardiac surgery (37). Thus, to improve health and quality of life for this large and heterogeneous group of patients, it is critical that rehabilitation efforts include cough (4,15,31,38).…”