Skip to main content
SpringerLink
Log in

Variability of Voluntary Cough Airflow in Healthy Adults and Parkinson’s Disease

  • Original Article
  • Published:
Dysphagia Aims and scope Submit manuscript

Abstract

Cough is an important airway protective behavior responsible for ejecting material from the airway to prevent pneumonia, a leading cause of death in older adults and individuals with Parkinson’s disease (PD). Variability of motor performance for both spinal and bulbar functions has been documented; however, there are no studies examining variability of cough motor control in PD and healthy controls. The present study examined the effects of age and PD on variability of voluntary cough performance. Twenty-five healthy younger adults (HYA), 26 healthy older adults (HOA), and 16 participants with PD completed three trials of sequential voluntary cough with spirometry. Coefficients of variation were used to examine variability between groups. Increased variability of cough expired volume (p = 0.012) and inspiratory volume (p = 0.006) was appreciated in HOAs compared to HYAs. Participants with PD demonstrated increased variability of cough expired volume (p = 0.029), peak expiratory flow rise time (p = 0.016), and cough volume acceleration (p = 0.034) compared to HOAs. Though participants with PD descriptively demonstrated increased peak expiratory flow rate compared to HOAs, this finding was statistically nonsignificant after adjusting for multiple comparisons (p = 0.072). This study identified that variability in cough airflow increases in healthy aging and Parkinson’s disease. These motor control impairments may be attributed to age and disease-related sensorimotor changes in the peripheral and central nervous system. Future research will be necessary to examine the relationship between inconsistent cough motor output, airway invasion, and aspiration pneumonia in PD.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Hegland KW, Okun MS, Troche MS. Sequential voluntary cough and aspiration or aspiration risk in Parkinson’s disease. Lung. 2014;192(4):601–8.

    Article  Google Scholar 

  2. Pitts T, Troche M, Mann G, Rosenbek J, Okun MS, Sapienza C. Using voluntary cough to detect penetration and aspiration during oropharyngeal swallowing in patients with Parkinson disease. Chest. 2010;138(6):1426–31.

    Article  Google Scholar 

  3. Bianchi C, Baiardi P, Khirani S, Cantarella G. Cough peak flow as a predictor of pulmonary morbidity in patients with dysphagia. Am J Phys Med Rehabil. 2012;91(9):783–8.

    Article  Google Scholar 

  4. Tunik E, Houk JC, Grafton ST. Basal ganglia contribution to the initiation of corrective submovements. NeuroImage. 2009;47(4):1757–66.

    Article  Google Scholar 

  5. Houk JC, Bastianen C, Fansler D, Fishbach A, Fraser D, Reber PJ, et al. Action selection and refinement in subcortical loops through basal ganglia and cerebellum. Phil Trans R Soc B. 2007;362(1485):1573–83.

    Article  CAS  Google Scholar 

  6. Dickson DW. Neuropathology of Parkinson disease. Parkinsonism RelatDisord. 2018;46:30–3.

    Article  Google Scholar 

  7. Reeves S, Bench C, Howard R. Ageing and the nigrostriatal dopaminergic system. Int J Geriat Psychiatry. 2002;17(4):359–70.

    Article  CAS  Google Scholar 

  8. Baltadjieva R, Giladi N, Gruendlinger L, Peretz C, Hausdorff JM. Marked alterations in the gait timing and rhythmicity of patients with de novo Parkinson’s disease. Eur J Neurosci. 2006;24(6):1815–20.

    Article  Google Scholar 

  9. Callisaya ML, Blizzard L, Schmidt MD, McGinley JL, Srikanth VK. Ageing and gait variability—a population-based study of older people. Age Ageing. 2010;39(2):191–7.

    Article  Google Scholar 

  10. Pradhan S, Scherer R, Matsuoka Y, Kelly VE. Grip force modulation characteristics as a marker for clinical disease progression in individuals with Parkinson disease: case-control study. Phys Ther. 2015;95(3):369–79.

    Article  Google Scholar 

  11. Vaillancourt DE, Slifkin AB, Newell KM. Inter-digit individuation and force variability in the precision grip of young, elderly, and Parkinson’s disease participants. Mot Control. 2002;6(2):113–28.

    Article  Google Scholar 

  12. Arias P, Robles-García V, Espinosa N, Corral Y, Cudeiro J. Validity of the finger tapping test in Parkinson’s disease, elderly and young healthy subjects: is there a role for central fatigue? Clin Neurophysiol. 2012;123(10):2034–41.

    Article  Google Scholar 

  13. Hausdorff JM, Rios DA, Edelberg HK. Gait variability and fall risk in community-living older adults: a 1-year prospective study. Arch Phys Med Rehabil. 2001;82(8):1050–6.

    Article  CAS  Google Scholar 

  14. Streicher M, Wirth R, Schindler K, Sieber CC, Hiesmayr M, Volkert D. Dysphagia in nursing homes—results from the NutritionDay Project. J Am Med Directors Assoc. 2018;19(2):141–147.e2.

    Article  Google Scholar 

  15. Serra-Prat M, Palomera M, Gomez C, Sar-Shalom D, Saiz A, Montoya JG, et al. Oropharyngeal dysphagia as a risk factor for malnutrition and lower respiratory tract infection in independently living older persons: a population-based prospective study. Age Ageing. 2012;41(3):376–81.

    Article  Google Scholar 

  16. Langmore SE, Terpenning MS, Schork A, Chen Y, Murray JT, Lopatin D, et al. Predictors of aspiration pneumonia: how important is dysphagia? Dysphagia. 1998;13(2):69–81.

    Article  CAS  Google Scholar 

  17. Molfenter SM, Steele CM. Physiological variability in the deglutition literature: hyoid and laryngeal kinematics. Dysphagia. 2011;26(1):67–74.

    Article  Google Scholar 

  18. Molfenter SM, Steele CM. Temporal variability in the deglutition literature. Dysphagia. 2012;27(2):162–77.

    Article  Google Scholar 

  19. Jones CA, Ciucci MR. Multimodal swallowing evaluation with high-resolution manometry reveals subtle swallowing changes in early and mid-stage Parkinson disease. JPD. 2016;6(1):197–208.

    Article  Google Scholar 

  20. Akbar U, Dham B, He Y, Hack N, Wu S, Troche M, et al. Incidence and mortality trends of aspiration pneumonia in Parkinson’s disease in the United States, 1979–2010. Parkinsonism RelatDisord. 2015;21(9):1082–6.

    Article  Google Scholar 

  21. Brandimore AE, Hegland KW, Okun MS, Davenport PW, Troche MS. Voluntary upregulation of reflex cough is possible in healthy older adults and Parkinson’s disease. J ApplPhysiol. 2017;123(1):19–26.

    Google Scholar 

  22. Brandimore AE, Troche MS, Huber JE, Hegland KW. Respiratory kinematic and airflow differences between reflex and voluntary cough in healthy young adults. Front Physiol. 2015;6:1–10.

    Article  Google Scholar 

  23. Hughes AJ, Daniel SE, Kilford L, Lees AJ. Accuracy of clinical diagnosis of idiopathic Parkinson’s disease: a clinico-pathological study of 100 cases. J Neurol Neurosurg Psychiatry. 1992;55(3):181–4.

    Article  CAS  Google Scholar 

  24. Davenport PW, Bolser DC, Vickroy T, Berry RB, Martin AD, Hey JA, et al. The effect of codeine on the Urge-to-Cough response to inhaled capsaicin. Pulm Pharmacol Ther. 2007;20(4):338–46.

    Article  CAS  Google Scholar 

  25. Cohen J. A power primer. Quant Methods Psychol. 1992;112(1):155–9.

    CAS  Google Scholar 

  26. R Core Team. R: a language and environment for statistical computing [Internet]. Vienna, Austria: R Foundation for Statistical Computing; 2018. https://www.R-project.org/

  27. Marik PE, Kaplan D. Aspiration pneumonia and dysphagia in the elderly. Chest. 2003;124(1):328–36.

    Article  Google Scholar 

  28. Hely MA, Morris JGL, Traficante R, Reid WGJ, O’Sullivan DJ, Williamson PM. The Sydney multicentre study of Parkinson’s disease: progression and mortality at 10 years. J Neurol Neurosurg Psychiatry. 1999;67(3):300–7.

    Article  CAS  Google Scholar 

  29. Fall P-A, Saleh A, Fredrickson M, Olsson J-E, Granérus A-K. Survival time, mortality, and cause of death in elderly patients with Parkinson’s disease. A 9-year follow-up: mortality in Parkinson’s disease. MovDisord. 2003;18(11):1312–6.

    Google Scholar 

  30. Yamada H, Masuda T, Okada M. Age-related EMG variables during maximum voluntary contraction. Percept Mot Skills. 2008;95:10–4.

    Article  Google Scholar 

  31. Ketcham C, Stelmach G. Movement control in the older adult, vol. 3. Washington, D.C: National Academies Press; 2004. p. 305.

    Google Scholar 

  32. Elliott JE, Greising SM, Mantilla CB, Sieck GC. Functional impact of sarcopenia in respiratory muscles. Respir Physiol Neurobiol. 2016;226:137–46.

    Article  CAS  Google Scholar 

  33. Kim J, Sapienza CM. Implications of expiratory muscle strength training for rehabilitation of the elderly: tutorial. JRRD. 2005;42(2):183–95.

    Article  Google Scholar 

  34. Berardelli A. Pathophysiology of bradykinesia in Parkinson’s disease. Brain. 2001;124(11):2131–46.

    Article  CAS  Google Scholar 

  35. Berardelli A, Sabra AF, Hallett M. Physiological mechanisms of rigidity in Parkinson’s disease. J Neurol Neurosurg Psychiatry. 1983;46(1):45–53.

    Article  CAS  Google Scholar 

  36. van Geert P, van Dijk M. Focus on variability: new tools to study intra-individual variability in developmental data. Infant Behav Dev. 2002;25(4):340–74.

    Article  Google Scholar 

Download references

Funding

N/A.

Author information

Authors and Affiliations

  1. Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, 525 West 120th Street, New York, NY, 10027, USA

    James C. Borders & Michelle S. Troche

  2. Department of Communication Science and Disorders, University of South Florida, Tampa, FL, 33703, USA

    Alexandra E. Brandimore

Authors
  1. James C. Borders
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alexandra E. Brandimore
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Michelle S. Troche
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to James C. Borders.

Ethics declarations

Conflict of interest

The authors have no conflicts of interest to disclose.

Ethical Approval

All procedures performed were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all participants prior to enrollment in this research study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Borders, J.C., Brandimore, A.E. & Troche, M.S. Variability of Voluntary Cough Airflow in Healthy Adults and Parkinson’s Disease. Dysphagia 36, 700–706 (2021). https://doi.org/10.1007/s00455-020-10190-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00455-020-10190-3

Keywords

Search

Navigation