Reflex vs. volitional cough differences amongst head and neck cancer survivors characterized by time since treatment and aspiration status

Fullerton, Amy; Mou, Yuhan; Silver, Natalie L.; Chheda, Neil N.; Hitchcock, Kathryn; Wheeler-Hegland, Karen

doi:10.1016/j.resp.2021.103702

Cited by 7 publications

(6 citation statements)

References 36 publications

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“…Participants continued to breathe through the face mask while making sensory ratings. To reduce the effects of sensory adaptation between trial presentations, participants breathed room air without the face mask for a minimum of 60-s intervals as previously described ( Dicpinigaitis, 2003 ; Fullerton et al, 2021 ). No specified number of breath cycles was recorded prior to stimulus delivery.…”

Section: Methodsmentioning

confidence: 99%

Characterization of Ethyl Butyrate–Induced Cough Before and After Breath Control Techniques in Healthy Adults

Novaleski

Wheeler-Hegland

Aleksandruk

et al. 2023

Am J Speech Lang Pathol

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Purpose: Methods for cough elicitation frequently involve aerosolized tussive agents. Here, we sought to determine whether healthy individuals demonstrate a quantifiable cough response after inhaling a volatile ester and if breath control techniques modify this chemically induced cough response. Method: Sixty adult male and female participants inhaled prepared liquid dilutions of ethyl butyrate dissolved in paraffin oil at 20%, 40%, and 60% v/v concentrations in triplicate, with presentation order randomized. We delivered stimuli through a face mask connected to an olfactometer and respiratory pneumotachograph. Participants rated sensations of their urge to cough and pleasantness of the odor while cough airflow was measured. Following baseline testing, participants were randomized to implement pursed-lip breathing or slow-paced breathing after inhaling ethyl butyrate to determine the effects of breath control on cough measures. Results: Inhaled ethyl butyrate elicited cough in 70% of participants. Higher concentrations of ethyl butyrate resulted in significantly greater sensation of the urge to cough, F (2, 80) = 10.72, p < .001, and significantly more generated coughs, F (2, 63) = 13.14, p < .001. Compared to baseline, participants rated significantly decreased urge to cough during breath control techniques, F (1, 40) = 11.01, p = .0019. No significant changes were observed in the number of generated coughs between baseline and breath control techniques, F (1, 31) = 7.23, p = .01. Conclusions: Airborne ethyl butyrate is a tussigenic agent in humans. Our findings provide opportunities for future research directions in normal and disordered cough responses to volatile compounds.

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Section: Methodsmentioning

confidence: 99%

Characterization of Ethyl Butyrate–Induced Cough Before and After Breath Control Techniques in Healthy Adults

Novaleski

Wheeler-Hegland

Aleksandruk

et al. 2023

Am J Speech Lang Pathol

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“…This understanding has led to new therapeutic approaches, adding skill training to traditional strengthening approaches [ 79 ]. Fullerton et al [ 80 ] studied changes in reflexive and volitional cough parameters after radiotherapy, postulating that cortical plasticity might be used to overcome fibrosis-linked impairments. However, while cough skill training approaches have proven successful in neurological conditions [ 81 , 82 ], studies in HNC are lacking.…”

Section: Developing Areasmentioning

confidence: 99%

Post-Radiotherapy Dysphagia in Head and Neck Cancer: Current Management by Speech-Language Pathologists

Govender,

Gilbody,

Simson

et al. 2024

Curr. Treat. Options in Oncol.

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Opinion statementDysphagia, difficulty in eating and drinking, remains the most common side effect of radiotherapy treatment for head and neck cancer (HNC) with devastating consequences for function and quality of life (QOL). Over the past decade, 5-year survival has improved due to multiple factors including treatment advances, reduction in smoking, introduction of the human papillomavirus (HPV) vaccine and more favourable prognosis of HPV-related cancers. Increased prevalence of HPV-positive disease, which tends to affect younger individuals, has led to an elevated number of people living for longer with the sequelae of cancer and its treatment. Symptoms are compounded by late effects of radiotherapy which may lead to worsening of dysphagia for some long-term survivors or new-onset dysphagia for others. Speech-language pathology (SLP) input remains core to the assessment and management of dysphagia following HNC treatment. In this article, we present current SLP management of dysphagia post-radiotherapy. We discuss conventional treatment approaches, the emergence of therapy adjuncts and current service delivery models. The impact of adherence on therapy outcomes is highlighted. Despite treatment advancements, patients continue to present with dysphagia which is resistant to existing intervention approaches. There is wide variation in treatment programmes, with a paucity of evidence to support optimal type, timing and intensity of treatment. We discuss the need for further research, including exploration of the impact of radiotherapy on the central nervous system (CNS), the link between sarcopenia and radiotherapy-induced dysphagia and the benefits of visual biofeedback in rehabilitation.

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“…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 ).…”

Section: Introductionmentioning

confidence: 99%

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

Dallal-York,

Troche

2024

Front. Rehabil. Sci.

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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.

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Reflex vs. volitional cough differences amongst head and neck cancer survivors characterized by time since treatment and aspiration status

Cited by 7 publications

References 36 publications

Characterization of Ethyl Butyrate–Induced Cough Before and After Breath Control Techniques in Healthy Adults

Characterization of Ethyl Butyrate–Induced Cough Before and After Breath Control Techniques in Healthy Adults

Post-Radiotherapy Dysphagia in Head and Neck Cancer: Current Management by Speech-Language Pathologists

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

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