Comparison of cough reflex test against instrumental assessment of aspiration

Abstract Background Silent aspiration is associated with pneumonia and mortality, and is poorly identified by traditional clinical swallowing evaluation (CSE). The aim of this study was to validate cough reflex testing (CRT) for identification of silent aspiration against aspiration confirmed by ins...

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Bibliographic Details
Published in:Physiology & behavior 2013-06, Vol.118, p.25-31
Main Authors: Miles, Anna, Moore, Sara, McFarlane, Mary, Lee, Fiona, Allen, Jacqueline, Huckabee, Maggie-Lee
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
atomization
Behavioral psychophysiology
Biological and medical sciences
Citric Acid
Cohort Studies
cough
Cough - chemically induced
Cough - physiopathology
Cough reflex testing
Data Interpretation, Statistical
deglutition
Deglutition - physiology
Dysphagia
Endoscopy
Esophagus
Female
Fluoroscopy
Fundamental and applied biological sciences. Psychology
Gastroenterology. Liver. Pancreas. Abdomen
Humans
Likelihood Functions
Male
Medical sciences
Middle Aged
mortality
Odds Ratio
Optical Fibers
Other diseases. Semiology
patients
Pneumology
pneumonia
Psychiatry
Psychology. Psychoanalysis. Psychiatry
Psychology. Psychophysiology
Reflex - physiology
Reproducibility of Results
researchers
Respiratory system : syndromes and miscellaneous diseases
Silent aspiration
Validity
Young Adult
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Summary:Abstract Background Silent aspiration is associated with pneumonia and mortality, and is poorly identified by traditional clinical swallowing evaluation (CSE). The aim of this study was to validate cough reflex testing (CRT) for identification of silent aspiration against aspiration confirmed by instrumental assessment. Methods Cough reflex threshold testing was completed on all patients using inhaled, nebulised citric acid. Within an hour, 80 patients underwent videofluoroscopic study of swallowing (VFSS) and 101 patients underwent fibreoptic endoscopic evaluation of swallowing (FEES). All tests were recorded and analysed by two researchers blinded to the result of the alternate test. Results Significant associations between CRT result and cough response to aspiration on VFSS (X2 (2) = 11.046, p = .003) and FEES (X2 (2) = 34.079, p < .001) were identified. Sensitivity and specificity were optimised at 0.6 mol/L in patients undergoing VFSS (71%, 60% respectively) and at 0.4 mol/L in patients undergoing FEES (69%, 71% respectively). A concentration of 0.8 mol/L had the highest odds ratio (OR) for detecting silent aspiration (8 based on VFSS; 7 based on FEES). Conclusion CRT results are significantly associated with aspiration response on instrumental assessment. Lower concentrations of citric acid provide a better predictive measure of silent aspiration.
ISSN:0031-9384
1873-507X
DOI:10.1016/j.physbeh.2013.05.004