Advertisement

Lung

, Volume 186, Supplement 1, pp 35–40 | Cite as

Cough and Aspiration of Food and Liquids Due to Oral Pharyngeal Dysphagia

  • Carol Smith Hammond
Article

Abstract

Oral pharyngeal dysphagia should be included in the differential diagnosis of patients with cough. Aspiration of food and liquid below the level of the true vocal folds observed on dynamic imaging studies i.e., videofluoroscopic (VSE) and endoscopic (FEES) evaluations of swallow, has been associated with pneumonia. Coughing while eating and drinking may indicate aspiration; however, aspiration may be clinically silent. Subjective patient, caregiver, and nurse reports of reflexive cough while eating are useful but limited in identifying patients who are at risk for aspiration. Objective measures of voluntary cough are under investigation to determine their capacity to predict the risk for aspiration and subsequent pneumonia. The treatment of dysphagic patients by a multidisciplinary team, including early evaluation by a speech-language pathologist, is associated with improved outcomes. Effective clinical interventions such as the use of compensatory swallowing strategies and the alteration of food consistencies should be based on the results of instrumental swallowing studies. Reflexive cough while eating and drinking is important for the detection of oral pharyngeal dysphagia and objective measure of voluntary cough may be a good screening tool for this condition.

Keywords

Aspiration Deglutition Reflexive cough Silent aspiration Speech-language pathologist Voluntary cough 

References

  1. 1.
    Doggett DL, Tappe KA, Mitchell MD, Chapell R, Coates V, Turkelson M (2001) Prevention of pneumonia in elderly stroke patients by systematic diagnosis and treatment of dysphagia: an evidence-based comprehensive analysis of the literature. Dysphagia 16:279–295PubMedCrossRefGoogle Scholar
  2. 2.
    Foley N, Finestone H, Woodbury MG, Teasell R, Geene Finestone L (2006) Energy and protein intakes of acute stroke patients. J Nutr Health Aging 10:171–175PubMedGoogle Scholar
  3. 3.
    Feinberg MJ, Ekberg O (1990) Deglutition after near-fatal choking episode: radiologic evaluation. Radiology 176:637–640PubMedGoogle Scholar
  4. 4.
    Ding R, Logemann JA (2000) Pneumonia in stroke patients: a retrospective study. Dysphagia 15:51–57PubMedGoogle Scholar
  5. 5.
    Smith Hammond CA, Goldstein LB (2006) Evidence-based clinical practice guidelines due to oral-pharyngeal dysphagia: ACCP cough and aspiration of food and liquids. Chest 129:154S–168SPubMedCrossRefGoogle Scholar
  6. 6.
    Mann G, Dip PG, Hankey GJ, Cameron D (1999) Swallowing function after stroke: prognosis and prognostic factors at 6 months. Stroke 30:744–748PubMedGoogle Scholar
  7. 7.
    Logemann JA (1986) Evaluation and treatment of swallowing disorders. College Hill Press, San DiegoGoogle Scholar
  8. 8.
    McCullough GH, Rosenbeck JC, Wertz RT, McCoy S, Mann G (2005) Utility of clinical swallowing examination measures for detecting aspiration post-stroke. J Speech Lang Hear Res 48:1280–1293PubMedCrossRefGoogle Scholar
  9. 9.
    Daggett A, Logemann J, Rademaker A, Pauloski B (2006) Laryngeal penetration during deglutition in normal subjects of various ages. Dysphagia 21:270–274PubMedCrossRefGoogle Scholar
  10. 10.
    Hiss SG, Strauss M, Treole K, Stuart A, Boutilier S (2004) Effects of age, gender, bolus volume, bolus viscosity, and gustation on swallowing apnea onset relative to lingual bolus propulsion onset in normal adults. Speech Lang Hear Res 47:572–583CrossRefGoogle Scholar
  11. 11.
    Youmans SR, Stierwalt JA (2006) Measures of tongue function related to normal swallowing. Dysphagia 21:102–111PubMedCrossRefGoogle Scholar
  12. 12.
    Bardan E, Kern M, Arndorfer RC, Hofmann C, Shaker R (2006) Effect of aging on bolus kinematics during the pharyngeal phase of swallowing. Am J Physiol Gastrointest Liver Physiol 290:G458–G465PubMedCrossRefGoogle Scholar
  13. 13.
    Xie P, Ren J, Bardan E, Mittal RK, Sui Z, Shaker R (1997) Frequency of gastroesophageal reflux events induced by pharyngeal water stimulation in young and elderly subjects. Am J Physiol 272:G233–G237PubMedGoogle Scholar
  14. 14.
    Pikus L, Levine MS, Yang YX, Rubesin SE, Katzka DA, Laufer I, Gefter WB (2003) Videofluoroscopic studies of swallowing dysfunction and the relative risk of pneumonia. AJR Am J Roentgenol 180:1613–1616PubMedGoogle Scholar
  15. 15.
    Agency for Health Care Policy and Research (1999) Diagnosis and treatment of swallowing disorders (dysphagia) in acute-care stroke patients: evidence report/technology assessment, No. 8. Washington, DC: Agency for Health Care Policy and Research, U.S. Department of Health and Human Services, AHCPR Publ. No. 99–E0249Google Scholar
  16. 16.
    Katzan IL, Dawson NV, Thomas L, Votruba ME, Cebul RD (2007) The cost of pneumonia after acute stroke. Neurology 68:1938–1943PubMedCrossRefGoogle Scholar
  17. 17.
    Shroeder M, Daniels SK, McClain M, Corye D, Foundas AL (2006) Clinical and cognitive predictors of swallowing recovery in stroke. J Rehabil Res Dev 43:301–310CrossRefGoogle Scholar
  18. 18.
    Mann G, Hankey GJ (2001) Initial clinical and demographic predictors of swallowing impairment following acute stroke. Dysphagia 16:208–215PubMedCrossRefGoogle Scholar
  19. 19.
    Shiba K, Nakazawa K, Ono K, Umezaki T (2007) Multifunctional laryngeal premotor neurons: their activities during breathing, coughing, sneezing and swallowing. J Neurosci 27:5156–5162PubMedCrossRefGoogle Scholar
  20. 20.
    Harada H, Takakusaki K, Kita S, Matsuda M, Nonaka S, Sakamoto T (2005) Effects of injecting GABAergic agents into the medullary reticular formation upon swallowing induced by superior laryngeal nerve stimulation in decerebrate cats. Neurosci Res 51:395–404PubMedCrossRefGoogle Scholar
  21. 21.
    Vergis E, Breunen C, Wagener M (2001) Pneumonia in long-term care: a prospective case control study of risk factors and impact on survival. Arch Intern Med 161:2378–2381PubMedCrossRefGoogle Scholar
  22. 22.
    Smith Hammond CA, Ying J, Horner RD, Goldstein LB, Gray L, Gonzalez-Rothi L, Bolser DC (2006) Comparison between reflexive cough after water swallow to aerodynamic measures of voluntary cough to identify patients with stroke-related dysphagia at risk of aspiration. Poster presented at the Department of Veterans Affairs Health Services Research & Development Meeting: Managing Recovery and Health through the Continuum of Care, Arlington, VAGoogle Scholar
  23. 23.
    Smith Hammond CA, Goldstein LB, Zajac DJ, Gray L, Davenport PW, Bolser DC (2001) Assessment of aspiration risk in stroke patients with quantification of voluntary cough. Neurology 56:502–506PubMedGoogle Scholar
  24. 24.
    Fontana GA, Pantaleo T, Lavorini F, Mutolo D, Polli G, Pistolesi M (1999) Coughing in laryngectomized patients. Am J Respir Crit Care Med 160:1578–1584PubMedGoogle Scholar
  25. 25.
    Stephens RE, Addington WR, Widdicombe JG (2003) Effect of acute unilateral middle cerebral artery infarcts on voluntary cough and the laryngeal cough reflex. Am J Phys Med Rehabil 82:379–383PubMedCrossRefGoogle Scholar
  26. 26.
    Katsumata U, Sekizawa K, Ebihara T, Sasaki H (1995) Aging effects on cough reflex. Chest 107:290–291PubMedCrossRefGoogle Scholar
  27. 27.
    Smith PE, Wiles CM (1998) Cough responsiveness in neurogenic dysphagia. J Neurol Neurosurg Psychiatry 64:385–388PubMedCrossRefGoogle Scholar
  28. 28.
    Niimi A, Matsumoto H, Ueda T, Takemura M, Suzuki K, Tanaka E, Chin K, Mishima M, Amitani R (2003) Impaired cough reflex in patients with recurrent pneumonia. Thorax 58:152–153PubMedCrossRefGoogle Scholar
  29. 29.
    Nakajoh K, Nakagawa T, Sekizawa K, Matsui T, Arai H, Sasaki H (2000) Relation between incidence of pneumonia and protective reflexes in post-stroke patients with oral or tube feeding. J Intern Med 247:39–42PubMedCrossRefGoogle Scholar
  30. 30.
    Addington WR, Stephens RE, Gilliland KA (1999) Assessing the laryngeal cough reflex and the risk of developing pneumonia after stroke: an interhospital comparison. Stroke 30:1203–1207PubMedGoogle Scholar
  31. 31.
    Carnaby G, Hankey GJ, Pizzi J (2006) Behavioral intervention for dysphagia in acute stroke: a randomized controlled trial. Lancet Neurol 5:31–37PubMedCrossRefGoogle Scholar
  32. 32.
    Arai T, Yasuda Y, Taakaya T (1998) ACE inhibitors and symptomless dysphagia. Lancet 352:115–116PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  1. 1.Audiology and Speech Pathology, Durham Veterans Affairs Medical Center, and Department of General and Internal MedicineDuke UniversityDurhamUSA

Personalised recommendations