Decreased Cough Sensitivity and Aspiration in Parkinson Disease
Decreased Cough Sensitivity and Aspiration in Parkinson Disease
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DOI：
10.1378/chest.14-0066
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发表时间：
2014-11-01
期刊：
影响因子：
9.6
通讯作者：
Hegland, Karen W.
中科院分区：
文献类型：
--
作者：
Troche, Michelle S.;Brandimore, Alexandra E.;Hegland, Karen W.
背景：吸入性肺炎是帕金森病（PD）患者死亡的主要原因。这些感染的发病机制主要归因于存在吞咽困难伴无声吸入或无适当咳嗽反应的吸入。本研究的目的是测试反射性咳嗽阈值和相关的urge-to-cough（UTC）评级与PD和无dysphagia.METHODS：20参与者PD招募本研究。他们用0、50、100和200 mM辣椒素的三个随机区组完成辣椒素挑战，并通过修改的博格量表评定他们的UTC。测量引起两次咳嗽反应的辣椒素浓度、咳嗽总数和参与者对咳嗽刺激的敏感性（UTC）。与PD的参与者的吞咽困难的严重程度被确定与渗透-抽吸scale.RESULTS：大多数参与者与PD没有一致的两个咳嗽响应200 mM辣椒素。UTC评级和咳嗽总数在200 mM辣椒素产生的吞咽困难的严重程度显着影响，但一般PD的严重程度，年龄，或疾病持续时间。吞咽困难严重程度的增加导致咳嗽敏感性显著减弱（UTC）。结论：UTC评级可能对了解PD和吞咽困难患者吸入性肺炎相关发病机制非常重要。进一步了解PD和吞咽困难患者的UTC降低对于制定解决该人群气道保护缺陷的策略和治疗至关重要。
BACKGROUND: Aspiration pneumonia is a leading cause of death in people with Parkinson disease (PD). The pathogenesis of these infections is largely attributed to the presence of dysphagia with silent aspiration or aspiration without an appropriate cough response. The goal of this study was to test reflex cough thresholds and associated urge-to-cough (UTC) ratings in participants with PD with and without dysphagia.METHODS: Twenty participants with PD were recruited for this study. They completed a capsaicin challenge with three randomized blocks of 0, 50, 100, and 200 m M capsaicin and rated their UTC by modified Borg scale. The concentration of capsaicin that elicited a two-cough response, total number of coughs, and sensitivity of the participant to the cough stimulus (UTC) were measured. The dysphagia severity of participants with PD was identified with the penetration-aspiration scale.RESULTS: Most participants with PD did not have a consistent two-cough response to 200 m M capsaicin. UTC ratings and total number of coughs produced at 200 m M capsaicin were significantly influenced by dysphagia severity but not by general PD severity, age, or disease duration. Increasing levels of dysphagia severity resulted in significantly blunted cough sensitivity (UTC).CONCLUSIONS: UTC ratings may be important in understanding the mechanism underlying morbidity related to aspiration pneumonia in people with PD and dysphagia. Further understanding of decreased UTC in people with PD and dysphagia will be essential for the development of strategies and treatments to address airway protection deficits in this population.