Respiration
Clinical Investigations
Cough Efficacy Is Related to the Disability Status in Patients with Multiple SclerosisAiello M.a · Rampello A.a, c · Granella F.b · Maestrelli M.a · Tzani P.a · Immovilli P.b · Franceschini M.c · Olivieri D.a · Chetta A.aDepartments of aClinical Sciences and bNeurosciences, University of Parma, and cDepartment of Rehabilitation and Gerontology, University Hospital of Parma, Parma, Italy
|
|
Log in to MyKarger to check if you already have access to this content.
KAB
Buy a Karger Article Bundle (KAB) and profit from a discount!
If you would like to redeem your KAB credit, please log in.
Save over 20% compared to the individual article price.
Article / Publication Details
Received: July 09, 2007
Accepted: November 22, 2007
Published online: March 04, 2008
Issue release date: September 2008
Number of Print Pages: 6
Number of Figures: 3
Number of Tables: 2
ISSN: 0025-7931 (Print)
eISSN: 1423-0356 (Online)
For additional information: https://www.karger.com/RES
Abstract
Background: Cough is an important defense mechanism, whose main function is to remove mucus and/or foreign bodies from the airways. In patients with multiple sclerosis (MS), respiratory muscle function may be affected and cough may be impaired. Objectives: Respiratory muscle strength and voluntary cough efficacy were determined in MS patients and controls, and the relationship between cough efficacy and patients’ degree of disability was investigated. Methods: We recruited 27 MS patients (age: 41 ± 11 years; 18 females) with mild-to-moderate disability, Expanded Disability Status Scale (EDSS) score range: 1–7, and 20 healthy controls (age: 37 ± 11 years; 12 females). The maximal inspiratory (PIMAX) and expiratory (PEMAX) pressures, maximal whistle mouth pressures (PMOW), cough peak flows (CPF), cough expiratory volumes (CEV) and cough gastric pressures (PGA) were measured in all subjects. Results: In MS patients, the EDSS score was significantly related to CPF, PEMAX, PMOW, cough PGA, PIMAX and CEV (p < 0.01, each correlation). The receiver-operating characteristic curve showed that an EDSS score ≧5.5 was consistent with impaired cough (CPF ≤5.6 l/s), with a sensitivity of 0.85 and a specificity of 0.95 (area under curve 0.90, p < 0.001). CPF was related to and predicted by PEMAX, PMOW, cough PGA and PIMAX in MS patients (p < 0.01 each correlation), but not in controls. Conclusions: MS can affect voluntary cough efficacy and respiratory muscle strength, which are inversely related to the patients’ degree of disability. In addition, this study shows that CPF is a measure of clinical relevance in MS patients.
© 2008 S. Karger AG, Basel
Related Articles:
References
- Yanagihara N, Von Leden H, Werner-Kukuk E: The physical parameters of cough: the larynx in a normal single cough. Acta Otolaryngol 1966;61:495–510.
-
Gosselink R, Kovacs L, Ketelaer P, Carton H, Decramer M: Respiratory muscle weakness and respiratory muscle training in severely disabled multiple sclerosis patients. Arch Phys Med Rehabil 2000;80:747–751.
- Smeltzer SC, Utell MJ, Rudick RA, Herndon RM: Pulmonary function and dysfunction in multiple sclerosis. Arch Neurol 1988;45:1245–1249.
- Foglio K, Clini E, Facchetti D, Vitacca M, Marangoni S, Bonomelli M, Ambrosino N: Respiratory muscle function and exercise capacity in multiple sclerosis. Eur Respir J 1994;7:23–28.
- Buyse B, Demedts M, Meekers J, Vandegaer L, Rochette F, Kerkhofs L: Respiratory dysfunction in multiple sclerosis: a prospective analysis of 60 patients. Eur Respir J 1997;10:139–145.
- Sadovnick AD, Eisen K, Ebers GC, Pary DW: Cause of death in patients attending multiple sclerosis clinics. Neurology 1991;41:1193–1196.
- Phadke JG: Survival pattern and cause of death in patients with multiple sclerosis: results from an epidemiological survey in north east Scotland. J Neuronal Neurosurg Psychiatry 1987;50:523–531.
- Midgard R, Riise T, Kvale G, Nyland H: Disability and mortality in multiple sclerosis in western Norway. Acta Neurol Scand 1996;93:307–314.
- Kurtze JF: Rating neurological impairment in multiple sclerosis: an expanded disability status scale (EDSS). Neurology 1983;33:1444–1452.
-
Quanjer PH, Tammeling GJ, Cotes JE, Pedersen OF, Peslin R, Yernault JC: Lung volumes and forced ventilatory flows. Report Working Party Standardization of Lung Function Tests, European Community for Steel and Coal. Official Statement of the European Respiratory Society. Eur Respir J 1993;16:5–40.
External Resources
- Wilson SH, Cooke NT, Edwards RHT, Spiro SG: Predicted normal values for maximal respiratory pressures in Caucasian adults and children. Thorax 1984;39:535–538.
- Chetta A, Harris ML, Lyall RA, Rafferty GF, Polkey MI, Olivieri D, Moxham J: Whistle mouth pressure as test of expiratory muscle strength. Eur Respir J 2001;17:688–695.
- Man WD, Kyroussis D, Fleming TA, Chetta A, Harraf F, Mustfa N, Rafferty GF, Polkey MI, Moxham J: Cough gastric pressure and maximum expiratory mouth pressure in humans. Am J Respir Crit Care Med 2003;168:714–717.
- Mustfa N, Aiello M, Lyall RA, Nikoletou D, Olivieri D, Leigh PN, Davidson AC, Polkey MI, Moxham J: Cough augmentation in amyotrophic lateral sclerosis. Neurology 2003;61:1285–1287.
- Zweig MH, Campbell G: Receiver-operating characteristic (ROC) plots: a fundamental evaluation tool in clinical medicine. Clin Chem 1993;39:561–577.
- Mutluay FK, Gürses HN, Saip S: Effects of multiple sclerosis on respiratory function. Clin Rehabil 2005;19:426–432.
- Smeltzer SC, Skurnick JH, Troiano R, Cook SD, Duran W, Lavietes MH: Respiratory function in multiple sclerosis. Utility of clinical assessment of respiratory muscle function. Chest 1992;101:479–484.
- Tantucci C, Massucci M, Piperno R, Betti L, Grassi V, Sorbini CA: Control of breathing and respiratory muscle strength in patients with multiple sclerosis. Chest 1994;105:1163–1170.
- Hadjikoutis S, Eccles R, Wiles CM: Coughing and choking in motor neuron disease. J Neurol Neurosurg Psychiatry 2000;68:601–604.
- Szeinberg A, Tabachnik E, Rashed N, McLaughlin FJ, England S, Bryan CA, Levison H: Cough capacity in patients with muscular dystrophy. Chest 1988;94:1232–1235.
- Bach JR, Ishikawa Y, Kim H: Prevention of pulmonary morbidity for patients with Duchenne muscular dystrophy. Chest 1997;112:1024–1028.
- Suarez AA, Pessolano FA, Monteiro SG, Ferreyra G, Capria ME, Mesa L, Dubrovsky A, De Vito EL: Peak flow and peak cough flow in the evaluation of expiratory muscle weakness and bulbar impairment in patients with neuromuscular disease. Am J Phys Med Rehabil 2002;81:506–511.
- Bach JR: Amyotrophic lateral sclerosis: prolongation of life by non-invasive respiratory aids. Chest 2002;122:92–98.
- Mansel JK, Norman JR: Respiratory complications and management of spinal cord injuries. Chest 1990;97:1446–1452.
- Ebihara S, Saito H, Kanda A, Nakajoh M, Takahashi H, Arai H, Sasaki H: Impaired efficacy of cough in patients with Parkinson disease. Chest 2003;124:1009–1015.
- Chiara T, Martin AD, Davenport PW, Bolser DC: Expiratory muscle strength training in persons with multiple sclerosis having mild to moderate disability: effect on maximal expiratory pressure, pulmonary function, and maximal voluntary cough. Arch Phys Med Rehabil 2006;87:468–473.
- Lasserson D, Mills K, Arunachalam R, Polkey M, Moxham J, Kalra L: Differences in motor activation of voluntary and reflex cough in humans. Thorax 2006;61:699–705.
- Marik PE, Kaplan D: Aspiration pneumonia and dysphagia in the elderly. Chest 2003;124:328–336.
- Smith Hammond CA, Goldstein LB, Zajac DJ, Gray L, Davenport PW, Bolser DC: Assessment of aspiration risk in stroke patients with quantification of voluntary cough. Neurology 2001;56:502–506.
Article / Publication Details
Received: July 09, 2007
Accepted: November 22, 2007
Published online: March 04, 2008
Issue release date: September 2008
Number of Print Pages: 6
Number of Figures: 3
Number of Tables: 2
ISSN: 0025-7931 (Print)
eISSN: 1423-0356 (Online)
For additional information: https://www.karger.com/RES
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
Get Permission
PubMed ID
