Determining peak cough flow cut-off values to predict aspiration pneumonia among patients with dysphagia using the citric acid reflexive cough test

Publication date: Available online 5 July 2018

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Donggyun Sohn, Geun-Young Park, HyungJung Koo, YongJun Jang, Yeonjae Han, Sun Im

Abstract

Objective

To investigate the clinical usefulness of the peak cough flow generated during the citric acid reflexive cough test (0.28 mol/L) by determining the appropriate cut-off values that could accurately predict aspiration pneumonia within the first 6 months after onset.

Design

Retrospective analysis of a prospectively maintained database.

Setting

University affiliated hospital.

Participants

Patients with first-ever diagnosed dysphagia attributable to cerebrovascular disease, who had undergone the citric acid reflexive cough test on the same day they underwent the instrumental assessment of swallowing, such as videofluoroscopy or the functional endoscopic swallowing test.

Interventions

Not applicable.

Main outcome measures

Peak cough flow (L/min) from the citric acid reflexive cough test.

Results

A final 163 patients had full medical records with 6-month follow-up. Receiver operating curve analysis showed that peak cough flow cut-off values set at 59 L/min were significantly associated with aspiration pneumonia [area under the curve (AUC) 95% confidence interval (CI) = 0.88 (0.83–0.93)]. This cut-off value significantly (P < 0.001) predicted the risk of aspiration pneumonia with an odds ratio of 21.56 (9.62–48.28). A multivariate regression logistic regression analysis model including initial dysphagia severity, low body mass index, and decreased level of cognition showed that inclusion of the peak cough flow from the citric acid reflexive cough test significantly improved the predictive model of aspiration pneumonia within the first 6 months after onset (AUC = 0.91 vs. 0.79).

Conclusions

Those with reflexive cough strength less than 59 L/min may be at high risk of respiratory infections within the first 6 months after dysphagia onset. Objective measurement of reflexive cough strength may help to predict those at risk of aspiration pneumonia.

https://ift.tt/2KO6MoB