Inhalation Therapy with Nebulized Capsaicin in a Patient with Oropharyngeal Dysphagia Post Stroke: A Clinical Case Report

Pekacka-Egli, Anna Maria; Herrmann, Jana; Spielmanns, Marc; Georg, Arthur; Schulz, Katharina; Zenker, Eveline; Windisch, Wolfram; Kulnik, Stefan Tino

doi:10.3390/geriatrics7020027

Cited by 3 publications

(2 citation statements)

References 51 publications

(54 reference statements)

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“…A possible hypothesis is that capsaicin should aid the clearance of the laryngopharynx and lower airways. In addition, a repeated trigger of the cough reflex might induce a central recovery of the cough reflex contributing to dysphagia rehabilitation as demonstrated in a recent case report in subjects affected by stroke [29] and in tracheostomized subjects affected by hemorrhagic stroke [30]. Another study conducted by Cui et al demonstrated an improvement in the swallowing function by combining ice and capsaicin stimulation in subjects with dysphagia after stroke [31].…”

Section: Discussionmentioning

confidence: 96%

Inducing Cough Reflex by Capsaicin Spray Stimulation in Patients with Acquired Brain Injury: A Preliminary Test and Proof of Concept

L¹,

Cortese²,

Quintieri³

et al. 2023

Preprint

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The cough assessment is fundamental in the weaning process as it gives information on the possibility to expel food and secretion from the airways. The majority of persons suffering from severe acquired brain injury (ABI) are not able to cough voluntarily due to severe motor deficits. In the present study, we evaluated the cough reflex in ABI patients using a new method based on a capsaicin spray stimulation test. 100 Healthy controls demographically matched with 50 ABI patients were included in this study. Clinical observations demonstrated robust cough response in both healthy controls and ABI patients, as well as the safety and tolerability of capsaicin spray stimulation. ABI patients with dysphagia were characterized by slower and delayed cough responses. Further studies are needed to validate this feasible, less-invasive, and simple-to-comprehend technique in inducing cough reflex. According to this preliminary evidence, we believe that this test might be translated into a simple and effective treatment to improve cough strength training reflexive cough modulation in ABI patients.

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Section: Discussionmentioning

confidence: 96%

Inducing Cough Reflex by Capsaicin Spray Stimulation in Patients with Acquired Brain Injury: A Preliminary Test and Proof of Concept

L¹,

Cortese²,

Quintieri³

et al. 2023

Preprint

View full text Add to dashboard Cite

show abstract

“…In addition, we defined the incidence of aspiration and the length of hospital stay as the secondary outcomes. In this meta-analysis, we included dysphagia-caused aspiration, a common stroke sequela caused by bulbar palsy, as it increases the risk of SAP ( 29 ).…”

Section: Methodsmentioning

confidence: 99%

Patient's care bundle benefits to prevent stroke associated pneumonia: A meta-analysis with trial sequential analysis

Guo¹,

Fan²,

Liu³

et al. 2022

Front. Neurol.

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BackgroundPatient's care bundle has been found to have a beneficial effect on refractory diseases, but the preventive effect of this strategy on stroke-associated pneumonia (SAP) remains unclear. The purpose of this meta-analysis was to determine the role of the patient's care bundle in the prevention of SAP.MethodsA systematic search was conducted in five electronic databases to identify randomized controlled trials (RCTs) published before January 31, 2022. The incidence of SAP and aspiration and the length of hospital stay were assessed. Random pair-wise meta-analysis was conducted using Review Manager 5.4, and trial sequential analysis (TSA) was also performed.ResultsTwenty eligible RCTs involving 1916 patients were included for data analysis. Pooled results suggested that patient's care bundle was associated with significantly lower incidence of SAP (risk ratio [RR], 0.37; 95% CI, 0.29–0.46; p < 0.001; I2 = 0%) and aspiration (RR, 0.23; 95% CI, 0.15–0.35; p < 0.001; I2 = 0%). Meanwhile, patient's care bundle also significantly shortened the length of hospital stay for general patients (mean difference [MD], −3.10; 95% CI, −3.83 to −2.37; p < 0.001; I2 = 16%) and the length of intensive care unit (ICU) stay for patients with severe stoke (MD, −4.85; 95% CI, −5.86−3.84; p < 0.001; I2 = 0%). Results of TSA confirmed that none of the findings could be significantly reversed by future studies.ConclusionsThe patient's care bundle effectively prevents the occurrence of SAP and aspiration and shortens the hospital stay of stroke patients. However, it is necessary to design more high-quality studies to further validate our findings and investigate their applicability in other geographical regions.

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Effect of Capsaicin Atomization on Cough and Swallowing Function in Patients With Hemorrhagic Stroke: A Randomized Controlled Trial

You-qin

Chen

et al. 2023

J Speech Lang Hear Res

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Background: Patients with hemorrhagic stroke have high mortality and disability rates. Nevertheless, early rehabilitation interventions can improve their outcomes. We aimed to apply capsaicin atomization as early intervention to patients with hemorrhagic stroke and explore improvements in cough and swallowing functions. Method: Patients with hemorrhagic stroke were randomly divided into the control group, which received routine care, and the intervention group, which underwent the capsaicin solution nebulization scheme in addition to routine care. Differences in the presence/absence of cough reflex and number of coughs in response to capsaicin, the presence/absence of swallowing reflex in response to water, the presence/absence of postswallow residue, substance P (SP) concentration, and pulmonary inflammation between the two groups were determined before and after the intervention. Results: A total of 53 patients with hemorrhagic stroke were included. Results showed no statistically significant difference in cough reflex in both groups after the intervention ( p > .05). The degree of cough in the intervention group was stronger than that in the control group ( p = .046). No statistically significant difference was observed in the number of patients with swallowing reflex in response to water between the groups ( p > .05). The presence/absence of postswallow residue of the intervention group was stronger than that of the control group ( p = .032). No statistically significant difference was observed between the Glasgow Coma Scale scores of the groups after the intervention ( p > .05). SP in the intervention group was significantly increased ( p = .031). The Clinical Pulmonary Infection Score was significantly lower in the control group, and the difference was statistically significant ( p = .028). Conclusions: Capsaicin nebulization can help enhance the number of coughs in response to capsaicin, reduce postswallow residue, and increase the level of SP in patients with hemorrhagic stroke and has a positive effect on pulmonary inflammation. This study provides intervention points for cough and swallowing rehabilitation after a hemorrhagic stroke. Supplemental Material: https://doi.org/10.23641/asha.21956903

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Inhalation Therapy with Nebulized Capsaicin in a Patient with Oropharyngeal Dysphagia Post Stroke: A Clinical Case Report

Cited by 3 publications

References 51 publications

Inducing Cough Reflex by Capsaicin Spray Stimulation in Patients with Acquired Brain Injury: A Preliminary Test and Proof of Concept

Inducing Cough Reflex by Capsaicin Spray Stimulation in Patients with Acquired Brain Injury: A Preliminary Test and Proof of Concept

Patient's care bundle benefits to prevent stroke associated pneumonia: A meta-analysis with trial sequential analysis

Effect of Capsaicin Atomization on Cough and Swallowing Function in Patients With Hemorrhagic Stroke: A Randomized Controlled Trial

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