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Determining Peak Cough Flow Cutoff Values to Predict Aspiration Pneumonia Among Patients With Dysphagia Using the Citric Acid Reflexive Cough Test

      Highlights

      • Reflexive cough strength ≤59 L/min may indicate high risk of respiratory infection.
      • Peak cough flow cutoff value improves accuracy of aspiration pneumonia prediction.
      • Objective measurement of reflexive cough strength may predict aspiration pneumonia.

      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 cutoff 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 (N=163) 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 cutoff values set at 59 L/min were significantly associated with aspiration pneumonia (area under the curve [AUC] 95% confidence interval =0.88 [0.83-0.93]). This cutoff value significantly (P<.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.

      Keywords

      List of abbreviations:

      AUC (area under the curve), BMI (body mass index), FOIS (Functional Oral Intake Scale), GDS (Global Deterioration Scale), MMSE (Mini-Mental State Examination), mRS (modified Rankin scale), OR (odds ratio), PCF (peak cough flow), ROC (receiver operating characteristic)
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