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Comparison of Two Methods for Inducing Reflex Cough in Patients With Parkinson’s Disease, With and Without Dysphagia

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Abstract

Aspiration pneumonia is a common cause of death in people with Parkinson’s disease (PD). Dysfunctional swallowing occurs in the majority of people with PD, and research has shown that cough function is also impaired. Previous studies suggest that testing reflex cough by having participants inhale a cough-inducing stimulus through a nebulizer may be a reliable indicator of swallowing dysfunction, or dysphagia. The primary goal of this study was to determine the cough response to two different cough-inducing stimuli in people with and without PD. The second goal of this study was to compare the cough response to the two different stimuli in people with PD, with and without swallowing dysfunction. Seventy adults (49 healthy and 21 with PD) participated in the study. Aerosolized water (fog) and 200 μM capsaicin were used to induce cough. Each substance was placed in a small, hand-held nebulizer, and presented to the participant. Each cough stimulus was presented three times. The total number of coughs produced to each stimulus trial was recorded. All participants coughed more to capsaicin versus fog (p < 0.001). A categorical ‘responder’ and ‘non-responder’ variable for the fog stimulus, defined as whether or not the participant coughed at least two times to two of three presentations of the stimulus, yields sensitivity of 77.8 % and a specificity of 90.9 % for identifying PD participants with and without dysphagia. The data show a differential response of the PD participants to the capsaicin versus fog stimuli. Clinically, this finding may allow for earlier identification of people with PD who are in need of a swallowing evaluation. As well, there are implications for the neural control of cough in this patient population.

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Acknowledgments

The authors would like to thank the participants and their families.

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Authors and Affiliations

  1. Department of Speech Language and Hearing Sciences, University of Florida, Box 117420, 336 Dauer Hall, Gainesville, FL, 32611, USA

    Karen W. Hegland & Alexandra Brandimore

  2. Department of Biobehavioral Sciences, Teacher’s College, Columbia University, New York, USA

    Michelle S. Troche

  3. Department of Neurology, University of Florida, Gainesville, USA

    Michael S. Okun

  4. Department of Physiological Sciences, University of Florida, Gainesville, USA

    Paul W. Davenport

Authors
  1. Karen W. Hegland
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  2. Michelle S. Troche
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  3. Alexandra Brandimore
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  4. Michael S. Okun
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  5. Paul W. Davenport
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Corresponding author

Correspondence to Karen W. Hegland.

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Conflict of interest

Dr. Hegland reports no disclosures related to this study. Dr. Hegland’s work is supported in part by the American Heart Association and BAE defense systems. Dr. Troche reports no disclosures or conflicts of interest related to this work. Ms. Brandimore reports no disclosures related to this study. Ms. Brandimore’s work is supported in part by a pre-doctoral fellowship through the Department of Veterans Affairs. Dr. Davenport reports no disclosures related to this study. Dr. Davenport’s research is supported by NIH and BAE defense systems. He also has financial interest in Aspire Products, LLC. Dr. Okun reports no disclosures related to this study. Dr. Okun serves as a consultant for the National Parkinson Foundation, and has received research grants from NIH, NPF, the Michael J. Fox Foundation, the Parkinson Alliance, Smallwood Foundation, the Bachmann-Strauss Foundation, the Tourette Syndrome Association, and the UF Foundation. Dr. Okun has previously received honoraria, but in the past > 36 months has received no support from industry. Dr. Okun has received royalties for publications with Demos, Manson, Amazon, and Cambridge (movement disorders books). Dr. Okun is an associate editor for New England Journal of Medicine Journal Watch Neurology. Dr. Okun has participated in CME activities on movement disorders in the last 36 months sponsored by PeerView, Prime, and by Vanderbilt University. The institution and not Dr. Okun receives grants from Medtronic and ANS/St. Jude, and the PI has no financial interest in these grants. Dr. Okun has participated as a site PI and/or co-I for several NIH, foundation, and industry sponsored trials over the years but has not received honoraria.

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Hegland, K.W., Troche, M.S., Brandimore, A. et al. Comparison of Two Methods for Inducing Reflex Cough in Patients With Parkinson’s Disease, With and Without Dysphagia. Dysphagia 31, 66–73 (2016). https://doi.org/10.1007/s00455-015-9659-5

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  • DOI: https://doi.org/10.1007/s00455-015-9659-5

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