Differences in the Peak Cough Flow among Stroke Patients With and Without Dysphagia

Kimura, Yoshiko; Takahashi, Masanori; Wada, Futoshi; Hachisuka, Kenji

doi:10.7888/juoeh.35.9

Cited by 25 publications

(24 citation statements)

References 15 publications

(13 reference statements)

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“…Patients diagnosed with dysphagia after stroke are known to exhibit a greater degree of diaphragm weakness than those without swallowing disturbance [3]. Accordingly, patients with stroke-related dysphagia are known to produce low PCF during VC compared to stroke patients without dysphagia and healthy controls [36]. In accordance, our results showed that those with PCF below 80 L/min showed increased severity of dysphagia and more respiratory infections.…”

Section: Discussionsupporting

confidence: 86%

Effect of brain lesions on voluntary cough in patients with supratentorial stroke: an observational study

Lee

Lim

Park

et al. 2020

Preprint

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Background: Patients with stroke are known to manifest decreased cough force, which may increase the risk of aspiration. Specific brain lesions have been linked to impaired reflexive cough. However, only a few studies investigated whether specific stroke lesions are associated with impaired voluntary cough. The present study analyzed the effects of stroke lesion on voluntary cough using voxel-based lesion-symptom mapping (VLSM).Methods : In this retrospective cross-sectional study, the peak cough flow was measured in patients who complained of weak cough (n = 39) after supratentorial lesions. Brain lesions were analyzed via magnetic resonance imaging (MRI) at the onset of stroke. These lesions were analyzed using VLSM.Results : The VLSM method with non-parametric mapping revealed that lesions in the sub-gyral frontal lobe, superior longitudinal and posterior corona radiata were related to weak cough flow. Also, lesions in the inferior parietal and temporal lobes, and both superior and mid-temporal gyrus were also associated with weak peak cough flow during voluntary coughing.Conclusions : The present study identified several brain lesions underlying impaired voluntary cough. The results may be useful in predicting those at risk of poor coughing function and may facilitate the prognosis of patients at increased risk of respiratory complications after stroke.

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Section: Discussionsupporting

confidence: 86%

Effect of brain lesions on voluntary cough in patients with supratentorial stroke: an observational study

Lee

Lim

Park

et al. 2020

Preprint

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“…According to a literature review, cough and swallow pattern generators are tightly coordinated because they share afferent and efferent pathways (6,8,10,27). The relationship between the coughing and swallowing function in stroke patients has been demonstrated in previous studies (5)(6)(7)(8)(9). Because the expiration-related muscles used in coughing are also used in the swallowing process, strengthening effect of the expirationrelated muscles through MIE exercise improves both coughing and swallowing function in stroke patients.…”

Section: Discussionmentioning

confidence: 99%

“…Coughing is an important protective mechanism for maintaining a clear airway. Several studies have revealed that stroke patients can experience a decrease in coughing function (5)(6)(7) and decreased coughing may be a predictive factor for aspiration pneumonia after stroke (7)(8)(9). Cough function is closely related to swallowing function and plays an important role in airway protection after stroke, since afferent and efferent pathways of the cough reflex are shared with that of the swallowing reflex (9,10).…”

mentioning

confidence: 99%

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Effects of mechanical inspiration and expiration exercise on velopharyngeal incompetence in subacute stroke patients

Jang¹,

Lee²,

Kim³

et al. 2019

J Rehabil Med

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Dysfunctional swallowing and coughing are common after stroke. These functions are closely related as they both use the same expiration-related muscles. Velopharyngeal incompetence (VPI) is one of the symptoms of swallowing and coughing dysfunction. However, there have been few studies regarding treatment of VPI. This study investigated the therapeutic effects of mechanical inspiration and expiration (MIE) exercise, using mechanical cough assist, on VPI in subacute stroke patients with dysphagia. The degree of nasal penetration and peak cough flow were improved to a greater extent in patients in the MIE exercise group. MIE exercise was effective on both swallowing and coughing function. This therapy is easy to apply in the clinical setting. Thus, MIE exercise may be a useful therapeutic strategy for VPI with dysphagia in patients with stroke. Objective: To investigate the therapeutic effects of mechanical inspiration and expiration exercise using mechanical cough assist on velopharyngeal incompetence in patients with subacute stroke. Design: Pilot, randomized controlled study. Setting: University-based rehabilitation centre. Subjects: Thirty-six patients with subacute stroke diagnosed with velopharyngeal incompetence by videofluoroscopic swallowing study. Methods: Subjects were randomly assigned to 2 groups. The study group received conventional dysphagia therapy and additional mechanical inspiration and expiration exercise. The control group received conventional dysphagia therapy only. Swallowing function was evaluated according to the American Speech-Language-Hearing association scale, functional dysphagia score, and the penetration aspiration scale, based on the videofluoroscopic swallowing study. Coughing function was measured using peak cough flow. Results: Eighteen patients in each group completed the protocol and were analysed. After treatment, the study group showed significant improvement in functional dysphagia score with regard to nasal penetration degree. Comparing the treatment effect between the 2 groups, nasal penetration degree and peak cough flow showed greater improvement in the study group. Conclusion: Mechanical inspiration and expiration exercise had a therapeutic effect on velopharyngeal incompetence in subacute stroke patients with dysphagia. This therapy is easy to provide clinically and could be a useful therapeutic strategy for velopharyngeal incompetence with dysphagia in patients with stroke.

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“…Various spirometers [3,[23][24][25][26] and peak flow meters [24,[26][27][28][29][30] are used for CPF measurement. Moreover, various flow sensors, such as a pneumotachograph [21,[23][24][25]31] that measures respiratory flow using differential pressure sensors, a constant temperature hot-wire flow sensor ( Figure 2a) [26,32] and an ultrasonic sensor [33], are used in spirometers. In particular, the peak flow meter that can measure the flow rate using a spring-loaded piston is most commonly used because of its small size and ease of use, enabling patients to measure CPF by themselves ( Figure 2b).…”

Section: Cough Mechanism and Related Factors Influencing Cpfmentioning

confidence: 99%

Clinical Significance of Cough Peak Flow and Its Non-Contact Measurement via Cough Sounds: A Narrative Review

et al. 2020

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Coughing is the primary defence mechanism against foreign bodies in the central airways and can quantitatively be assessed by cough peak flow (CPF). We conducted a narrative review of the literature on CPF, which is most commonly used for evaluating cough strength. This review regards the method for measurement of CPF, the cough-related factors influencing CPF, the clinical significance of CPF evaluation, and a novel cough strength prediction method using cough sounds. Furthermore, this review presents various cutoff thresholds that predict extubation failure in patients on mechanical ventilation, acute respiratory failure, and aspiration risk. The published clinical evidence of CPF demonstrates reasonable diagnostic accuracy, predictive power, and validity, although additional studies on the non-contact measurement of CPF via cough sounds with better-quality methodologies are required.

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Differences in the Peak Cough Flow among Stroke Patients With and Without Dysphagia

Cited by 25 publications

References 15 publications

Effect of brain lesions on voluntary cough in patients with supratentorial stroke: an observational study

Effect of brain lesions on voluntary cough in patients with supratentorial stroke: an observational study

Effects of mechanical inspiration and expiration exercise on velopharyngeal incompetence in subacute stroke patients

Clinical Significance of Cough Peak Flow and Its Non-Contact Measurement via Cough Sounds: A Narrative Review

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