Affiliation:
1. Aerodigestive Research Core Laboratory The Ohio State University Columbus Ohio USA
2. Department of Hearing and Speech Sciences Vanderbilt University Nashville Tennessee USA
3. Department of Anesthesiology University of Florida Gainesville Florida USA
4. Department of Neurology University of Florida Gainesville Florida USA
5. Department of Otolaryngology—Head and Neck Surgery The Ohio State University Columbus Ohio USA
Abstract
AbstractIntroduction/AimsEvaluations of pulmonary, cough, and swallow function are frequently performed to assess disease progression in amyotrophic lateral sclerosis (ALS), yet the relationship between these functions remains unknown. We therefore aimed to determine relationships between these measures in individuals with ALS.MethodsOne hundred individuals with ALS underwent standardized tests: forced vital capacity (FVC), maximum expiratory/inspiratory pressure (MEP, MIP), voluntary cough peak expiratory flow (PEF), and videofluoroscopic swallow evaluation (VF). Duplicate raters completed independent, blinded ratings using the Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) scale. Descriptives, Spearman's Rho correlations, Kruskal–Wallis analyses, and Pearson's chi‐squared tests were completed.ResultsMean and standard deviation across pulmonary and cough measures were FVC: 74.2% predicted (± 22.6), MEP: 91.6 cmH2O (± 46.4), MIP cmH2O: 61.1 (± 28.9), voluntary PEF: 352.7 L/min (± 141.6). DIGEST grades included: 0 (normal swallowing): 31%, 1 (mild dysphagia): 48%, 2 (moderate dysphagia): 10%, 3 (severe dysphagia): 10%, and 4 (life‐threatening dysphagia): 1%. Positive correlations were observed: MEP‐MIP: r = .76, MIP‐PEF: r = .68, MEP‐PEF: r = .61, MIP‐FVC: r = .60, PEF‐FVC: r = .49, and MEP‐FVC: r = .46, p < .0001. MEP (p = .009) and PEF (p = .04) differed across DIGEST safety grades. Post hoc analyses revealed significant between group differences in MEP and PEF across DIGEST safety grades 0 versus 1 and grades 0 versus 3, (p < .05).DiscussionIn this cohort of individuals with ALS, pulmonary function, and voluntary cough were associated. Expiratory metrics (MEP, PEF) were diminished in individuals with unsafe swallowing, increasing their risk for effectively defending the airway.
Funder
ALS Association
National Institute of Neurological Disorders and Stroke