, Volume 31, Issue 3, pp 383–390 | Cite as

Voluntary Cough Airflow Differentiates Safe Versus Unsafe Swallowing in Amyotrophic Lateral Sclerosis

  • Emily K. PlowmanEmail author
  • Stephanie A. Watts
  • Raele Robison
  • Lauren Tabor
  • Charles Dion
  • Joy Gaziano
  • Tuan Vu
  • Clifton Gooch
Original Article


Dysphagia and aspiration are prevalent in amyotrophic lateral sclerosis (ALS) and contribute to malnutrition, aspiration pneumonia, and death. Early detection of at risk individuals is critical to ensure maintenance of safe oral intake and optimal pulmonary function. We therefore aimed to determine the discriminant ability of voluntary cough airflow measures in detecting penetration/aspiration status in ALS patients. Seventy individuals with ALS (El-Escorial criteria) completed voluntary cough spirometry testing and underwent a standardized videofluoroscopic swallowing evaluation (VFSE). A rater blinded to aspiration status derived six objective measures of voluntary cough airflow and evaluated airway safety using the penetration–aspiration scale (PAS). A between groups ANOVA (safe vs. unsafe swallowers) was conducted and sensitivity, specificity, area under the curve (AUC) and likelihood ratios were calculated. VFSE analysis revealed 24 penetrator/aspirators (PAS ≥3) and 46 non-penetrator/aspirators (PAS ≤2). Cough volume acceleration (CVA), peak expiratory flow rise time (PEFRT), and peak expiratory flow rate (PEFR) were significantly different between airway safety groups (p < 0.05) and demonstrated significant discriminant ability to detect the presence of penetration/aspiration with AUC values of: 0.85, 0.81, and 0.78, respectively. CVA <45.28 L/s/s, PEFR <3.97 L/s, and PEFRT >76 ms had sensitivities of 91.3, 82.6, and 73.9 %, respectively, and specificities of 82.2, 73.9, and 78.3 % for identifying ALS penetrator/aspirators. Voluntary cough airflow measures identified ALS patients at risk for penetration/aspiration and may be a valuable screening tool with high clinical utility.


Deglutition Deglutition disorders Amyotrophic lateral sclerosis Aspiration Cough Screen 



This study was funded, in part, by Grant R21HD075327 from the National Institute of Child Health and Development.

Compliance with Ethical Standards

Conflict of interest



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Copyright information

© Springer Science+Business Media New York (outside the USA) 2016

Authors and Affiliations

  • Emily K. Plowman
    • 1
    • 2
    Email author
  • Stephanie A. Watts
    • 2
    • 3
  • Raele Robison
    • 1
    • 2
  • Lauren Tabor
    • 1
    • 2
  • Charles Dion
    • 3
  • Joy Gaziano
    • 3
  • Tuan Vu
    • 4
  • Clifton Gooch
    • 4
  1. 1.Department of Speech, Language and Hearing SciencesUniversity of FloridaGainesvilleUSA
  2. 2.Neuromotor Speech and Swallowing Restoration LaboratoryUniversity of FloridaGainesvilleUSA
  3. 3.Joy McCann Center for Swallowing DisordersUniversity of South FloridaTampaUSA
  4. 4.Department of NeurologyUniversity of South FloridaTampaUSA

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