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。呼吸道清除障碍会导致异物渗入声门下呼吸道，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%。迫切需要策略来加强对神经退行性疾病患者的呼吸道保护行为的筛查。虽然目前存在筛查工具来评估临床环境中的吸入风险，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矫正的呼吸道保护模式，因此提供的有关个体在发生误吸时保护其呼吸道的能力的信息有限。R21将包括两种不同的捕捉咳嗽气流峰值数据的设备与评估健康参与者和帕金森病患者咳嗽气流测量的更昂贵和技术要求更高的“金标准”气动测定仪方案的比较。首先，将从健康对照组和帕金森病患者生产的三种设备中分别收集咳嗽峰值流量数据。接下来，我们将定义健康对照组和帕金森病患者组在引起微弱、中度和强烈咳嗽时产生的咳嗽范围，以确定设备测量气流变化的能力。完成咳嗽测量仪器的内部可靠性和内部可靠性。帕金森病患者将从佛罗里达大学运动障碍中心招募。每个设备的可接受性将通过基于任务难度、不适感、疼痛和易用性的视觉模拟量表计算的总分来衡量。参与者和临床医生将分别使用不同的量表。仪表的可接受性将使用方差分析进行比较。使用受试者操作员曲线(ROC)对健康对照组和PD样本的呼气峰值气流表达装置的可比性进行评估。将计算曲线下面积(AUROC)，并使用假设检验对不同设备进行比较。R33旨在遵循R21阶段，以确定咳嗽高峰气流是否可以预测呼吸道穿透的存在和严重程度，这是由一组帕金森病患者完成的连续吞咽视频透视评估得出的PA评分所定义的。参与者将使用在R21部分中选择的设备测量最大咳嗽气流，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患者的咳嗽气流峰值和P-A评分之间的关系(如果有的话)。统计建模程序将为呼吸道损害提供一个初步的风险预测方程。

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.