Accuracy of Examining Cough Function and its Relationship to Airway Protection

描述（由申请人提供）： 吞咽困难和吸入性肺炎是帕金森病（PD）危及生命的主要原因。气道清除率受损导致异物渗透，从而“播种”声门下气道，导致吸入性肺炎的高患病率。吸入性肺炎的死亡率可接近40%。有一个迫切需要的战略，以加强筛选气道保护行为的神经退行性疾病患者。虽然目前存在评估临床环境中误吸风险的筛查工具，但它们主要评估吞咽功能。重要的是，吞咽筛查措施无法评估纠正气道保护模式，因此，如果发生吸入，关于个体保护其气道的能力的信息有限。R21将包括两种不同的用于采集峰值咳嗽气流数据的设备与更昂贵且技术要求更高的“黄金标准”呼吸速度描记器方案在健康参与者和PD患者咳嗽气流测量评估中的比较。首先，将从健康对照和PD个体产生的三种装置中的每一种收集咳嗽峰值流量数据。接下来，我们将定义健康对照组和PD组在诱发的弱、中、强咳嗽中产生的咳嗽范围，以确定设备测量气流变化的能力。将完成咳嗽测量器械的内部和内部可靠性。PD患者将从佛罗里达大学运动障碍中心招募。将通过基于任务难度、不适、疼痛和易用性感知的视觉模拟量表计算的总评分来测量每种器械的可接受性。将向参与者和临床医生提供单独的量表。将使用ANOVA进行血糖仪可接受性比较。将使用受试者工作曲线（ROC）审查器械在健康对照与PD样本中表达呼气峰气流的可比性。将计算曲线下面积（AUROC），并使用假设检验比较不同器械。R33旨在遵循R21阶段，以确定咳嗽峰值气流是否可以预测气道渗透的存在和严重程度，气道渗透由一组PD受试者完成的连续吞咽的视频透视评估得出的PA评分定义。受试者将使用在R21部分期间选择的设备测量峰值咳嗽气流，并在视频透视下接受吞咽功能评估。随后的统计分析将确定PD受试者咳嗽气流峰值测量值与P-A评分之间的关系（如有）。统计建模程序将提供气道受损风险的初步预测方程。

DESCRIPTION (provided by applicant): Dysphagia and aspiration pneumonia are the main cause of life-threatening morbidity in Parkinson's disease (PD). Impaired airway clearance leads to penetration of foreign material which "seeds" the subglottic airways resulting in a high prevalence of aspiration pneumonia. Mortality rates of aspiration pneumonia can approach 40%. There is a compelling need for strategies to enhance the screening of airway protective behaviors in patients with neurodegenerative disease. While screening tools currently exist to assess aspiration risk in clinical settings they primarily assess swallow function. Importantly, swallow screening measures are unable to assess corrective airway protection modalities and therefore give limited information as to an individual's ability to defend his or her airway, should aspiration occur. The R21 will comprise a comparison of two different devices for capturing peak cough airflow data to the more costly and technically demanding "gold standard" pneumotachograph protocol in the assessment of cough airflow measures in healthy participants and individuals with PD. First, cough peak flow data will be collected from each of the three devices produced by healthy controls and individuals with PD. Next, we will define the cough ranges produced within the healthy control and PD groups across elicited weak, moderate and strong coughs to determine the devices' ability to measure airflow change. Intra and inter - reliability of the devices for the measurement of cough will be completed. Participants with PD will be recruited from the University of Florida Movement Disorders Center. The acceptability of each device will be measured by a calculated total score based on visual analogue scales of perception of task difficulty, discomfort, pain, and ease of use. Separate scales will be administered to participants and clinicians. Comparison of meter acceptability will be conducted using ANOVA. The comparability of the devices for expressing expiratory peak airflow in healthy control vs. PD sample will be reviewed using receiver operator curves (ROC). Area under the curve will be calculated (AUROC) and compared for the different devices using hypothesis testing. The R33 aims follow the R21 phase to determine if cough peak airflow can predict the presence and severity of airway penetration as defined by PA scores made from videofluoroscopic assessment of sequential swallows completed by a cohort of participants with PD. Participants will undergo measurement of peak cough airflows using the device selected during the R21 portion and receive an assessment of swallowing function under videofluoroscopy. Subsequent statistical analyses will determine the relationship, if any, between measures of peak cough airflow and P-A scores for participants with PD. Statistical modeling procedures will provide a preliminary predictive equation of risk for airway compromise.