When it comes to functions that are vital to human beings, the ability to breathe clearly is hard to beat. Being able to cough, then, is particularly important for clearing foreign particles from the airway – and this is especially true in those with dysphagia who may be at risk for penetration/aspiration (P/A), such as Parkinson’s Disease (PD) patients. Without this ability, aspiration can occur during swallowing and potentially cause pneumonia, a leading cause of death in PD patients.

Research has been conducted in order to determine whether or not it is possible to improve vital functions like coughing and swallowing. The study discussed in this post exploers expiratory muscle strength training (EMST) as a potential method of improving the cough and swallow functions.

Key Findings

• Cough is important for airway clearance in patients with dysphagia who are at risk of penetration/aspiration, such as people with Parkinson’s disease.
• Aspiration can occur during swallowing, and can lead to pneumonia and death.
• Expiratory muscle training (EMT) improved cough volume acceleration and decreases in the penetration/aspiration score.

Patient Impact

RMT effectively improves cough and swallowing function in Parkinsons’ patients with dysphagia.

Study Methods

A variety of parameters from an airflow waveform produced during voluntary cough were measured in this study both pre-EMST and post-EMST. These include:
inspiratory phase duration.

Compression phase duration (CPD)

Expiratory phase peak flow (EPPF)

Expiratory phase rise time (EPRT)

Cough volume acceleration (VA)

In this study, the swallow outcome measure was the degree of P/A that occurred during the swallow task.

Study Results

The study found that there was a significant decrease in the duration of the CPD and EPRT after EMST. The decrease in EPRT resulted in a significant increase in cough VA. Significant decrease in the P/A scores were found to persist post training.

The results demonstrate that EMST is a viable treatment modality for a population of participants with PD who are at risk of aspiration.

References

Pitts T, et.al., Impact of Expiratory Muscle Strength Training on Voluntary Cough and Swallow Function in Parkinson Disease. – CHEST, 2009; 135(5),1301-8.