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Mootassim-Billah S, Schoentgen J, De Bodt M, Roper N, Digonnet A, Le Tensorer M, Van Nuffelen G, Van Gestel D. Acoustic Analysis of Voluntary Coughs, Throat Clearings, and Induced Reflexive Coughs in a Healthy Population. Dysphagia 2023; 38:1467-1486. [PMID: 37245187 PMCID: PMC10225042 DOI: 10.1007/s00455-023-10574-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 03/31/2023] [Indexed: 05/29/2023]
Abstract
Cough efficacy is considered a reliable predictor of the aspiration risk in head and neck cancer patients with radiation-associated dysphagia. Currently, coughing is assessed perceptually or aerodynamically. The goal of our research is to develop methods of acoustic cough analysis. In this study, we examined in a healthy population the acoustical differences between three protective maneuvers: voluntary cough, voluntary throat clearing, and induced reflexive cough. Forty healthy participants were included in this study. Voluntary cough, voluntary throat clearing, and reflexive cough samples were recorded and analyzed acoustically. Temporal acoustic features were the following: the slope and curvature of the amplitude contour, as well as the average, slope, and curvature of the sample entropy and kurtosis contours of the recorded signal. Spectral features were the relative energy in the frequency bands (0-400 Hz, 400-800 Hz, 800-1600 Hz, 1600 Hz-3200 Hz, > 3200 Hz) as well as the weighted spectral energy. Results showed that, compared to a voluntary cough, a throat clearing starts with a weaker onset pulse and involves oscillations from the onset to the offset (concave curvature of the amplitude contour, p < 0.05), lower average (p < 0.05), and slope (p < 0.05) as well as lower convex curvature (p < 0.05) of the kurtosis contour. An induced reflexive cough starts with a higher and briefer onset burst and includes higher frication noise (larger convexity of the curvature of the amplitude and kurtosis contours (p < 0.05)) compared to a voluntary cough. The conclusion is that voluntary coughs are acoustically significantly different from voluntary throat clearings and induced reflexive coughs.
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Affiliation(s)
- Sofiana Mootassim-Billah
- Department of Radiation Oncology, Speech Therapy, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium.
| | - Jean Schoentgen
- Department of Biomechatronics, Université Libre de Bruxelles, Brussels, Belgium
| | - Marc De Bodt
- Department of Otolaryngology and Head and Neck Surgery, University Rehabilitation Center for Communication Disorders, Antwerp University Hospital, Antwerp, Belgium
- Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Department of Logopaedics and Audiological Sciences, Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgium
| | - Nicolas Roper
- Department of Oto-Rhino-Laryngology and Head & Neck Surgery, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Antoine Digonnet
- Department of Surgical Oncology, Head and Neck Surgery Unit, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Mathilde Le Tensorer
- Speech Therapy Unit, Institut Jules Bordet, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Gwen Van Nuffelen
- Department of Otolaryngology and Head and Neck Surgery, University Rehabilitation Center for Communication Disorders, Antwerp University Hospital, Antwerp, Belgium
- Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Department of Logopaedics and Audiological Sciences, Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgium
| | - Dirk Van Gestel
- Department of Radiation Oncology, Head and Neck Unit, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
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Sheers NL, O’Sullivan R, Howard ME, Berlowitz DJ. The role of lung volume recruitment therapy in neuromuscular disease: a narrative review. FRONTIERS IN REHABILITATION SCIENCES 2023; 4:1164628. [PMID: 37565183 PMCID: PMC10410160 DOI: 10.3389/fresc.2023.1164628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 06/16/2023] [Indexed: 08/12/2023]
Abstract
Respiratory muscle weakness results in substantial discomfort, disability, and ultimately death in many neuromuscular diseases. Respiratory system impairment manifests as shallow breathing, poor cough and associated difficulty clearing mucus, respiratory tract infections, hypoventilation, sleep-disordered breathing, and chronic ventilatory failure. Ventilatory support (i.e., non-invasive ventilation) is an established and key treatment for the latter. As survival outcomes improve for people living with many neuromuscular diseases, there is a shift towards more proactive and preventative chronic disease multidisciplinary care models that aim to manage symptoms, improve morbidity, and reduce mortality. Clinical care guidelines typically recommend therapies to improve cough effectiveness and mobilise mucus, with the aim of averting acute respiratory compromise or respiratory tract infections. Moreover, preventing recurrent infective episodes may prevent secondary parenchymal pathology and further lung function decline. Regular use of techniques that augment lung volume has similarly been recommended (volume recruitment). It has been speculated that enhancing lung inflation in people with respiratory muscle weakness when well may improve respiratory system "flexibility", mitigate restrictive chest wall disease, and slow lung volume decline. Unfortunately, clinical care guidelines are based largely on clinical rationale and consensus opinion rather than level A evidence. This narrative review outlines the physiological changes that occur in people with neuromuscular disease and how these changes impact on breathing, cough, and respiratory tract infections. The biological rationale for lung volume recruitment is provided, and the clinical trials that examine the immediate, short-term, and longer-term outcomes of lung volume recruitment in paediatric and adult neuromuscular diseases are presented and the results synthesised.
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Affiliation(s)
- Nicole L. Sheers
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, VIC, Australia
- Institute for Breathing and Sleep, Heidelberg, VIC, Australia
- Department of Physiotherapy, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, VIC, Australia
| | - Rachel O’Sullivan
- Department of Physiotherapy, Christchurch Hospital, Canterbury, New Zealand
| | - Mark E. Howard
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, VIC, Australia
- Institute for Breathing and Sleep, Heidelberg, VIC, Australia
- Department of Medicine, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, VIC, Australia
- Turner Institute of Brain and Mental Health, Monash University, Clayton, VIC, Australia
| | - David J. Berlowitz
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, VIC, Australia
- Institute for Breathing and Sleep, Heidelberg, VIC, Australia
- Department of Physiotherapy, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, VIC, Australia
- Department of Physiotherapy, Austin Health, Heidelberg, VIC, Australia
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Kim JY, Davenport PW, Mou Y, Hegland K. Primary site of constriction during the compression phase of cough in healthy young adults. Respir Physiol Neurobiol 2023; 311:104033. [PMID: 36764504 PMCID: PMC10067529 DOI: 10.1016/j.resp.2023.104033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 01/27/2023] [Accepted: 02/06/2023] [Indexed: 02/11/2023]
Abstract
Glottal closure has been considered as the primary constriction point during the compression phase (CP); however, vocal fold adduction alone cannot resist the high pressures, providing motivation to explore other mechanisms contributing to that resistance. The goal of this study was to identify site(s) and degree of constriction during the CP of cough of varying types in healthy young adults. Twenty-five healthy young participants participated in this study. The experimental protocol was comprised of: 1) baseline pulmonary function measures; 2) cough practice to establish weak, moderate and strong coughs; 3) voluntary and reflex cough assessments with fluoroscopy and airflow measures. We used a repeated measures ANOVA to identify whether there are differences in constriction ratio between cough types. There was a significant difference in constriction of varying cough types. Degree of constriction in all cough strengths showed that the glottis was the most constricted area, followed by the laryngeal vestibule, nasopharynx, hypopharynx, oropharynx, and cervical trachea, in order, but stronger cough resulted in more constriction in all areas compared to weaker cough. Degree of constriction in reflex cough showed a similar pattern though there was greater constriction in the oropharynx than the hypopharynx. Airflow measures in voluntary cough were consistent with previous findings. Differences in upper airway constriction during the compression phase of cough may be attributed to differences in motor control between reflex and voluntary cough, and the increased constriction seen during strong cough may reflect increased muscle recruitment during that task. In the future, we can use this knowledge to develop novel methods for cough rehabilitation.
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Affiliation(s)
- Ja Young Kim
- Graduate Program in Speech-Language Pathology, Yonsei University, Yonsei-ro 50, Seodaemun-gu, Seoul, South Korea 03722.
| | - Paul W Davenport
- Department of Physiological Sciences, University of Florida, 1333 Center Drive, Gainesville, FL 32610, USA.
| | - Yuhan Mou
- Department of Rehabilitation Science, University of Florida, 1225 Center Drive, Gainesville, FL 32610, USA.
| | - Karen Hegland
- Department of Speech, Language, and Hearing Sciences, University of Florida, 1225 Center Drive, Gainesville, FL 32610, USA.
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Mootassim‐Billah S, Van Nuffelen G, Schoentgen J, De Bodt M, Dragan T, Digonnet A, Roper N, Van Gestel D. Assessment of cough in head and neck cancer patients at risk for dysphagia-An overview. Cancer Rep (Hoboken) 2021; 4:e1395. [PMID: 33932152 PMCID: PMC8551981 DOI: 10.1002/cnr2.1395] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 02/22/2021] [Accepted: 03/26/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND This literature review explores the terminology, the neurophysiology, and the assessment of cough in general, in the framework of dysphagia and regarding head and neck cancer patients at risk for dysphagia. In the dysphagic population, cough is currently assessed perceptually during a clinical swallowing evaluation or aerodynamically. RECENT FINDINGS Recent findings have shown intra and inter-rater disagreements regarding perceptual scoring of cough. Also, aerodynamic measurements are impractical in a routine bedside assessment. Coughing, however, is considered to be a clinically relevant sign of aspiration and dysphagia in head and cancer patients treated with concurrent chemoradiotherapy. CONCLUSION This article surveys the literature regarding the established cough assessment and stresses the need to implement innovative methods for assessing cough in head and neck cancer patients treated with concurrent chemoradiotherapy at risk for dysphagia.
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Affiliation(s)
- Sofiana Mootassim‐Billah
- Department of Radiation Oncology, Speech Therapy, Institut Jules BordetUniversité Libre de BruxellesBrusselsBelgium
| | - Gwen Van Nuffelen
- Department of Otolaryngology and Head and Neck Surgery, University Rehabilitation Center for Communication DisordersAntwerp University HospitalAntwerpBelgium
- Department of Translational Neurosciences, Faculty of Medicine and Health SciencesUniversity of AntwerpAntwerpBelgium
- Department of Logopaedics and Audiological Sciences, Faculty of Medicine and Health SciencesUniversity of GhentGhentBelgium
| | - Jean Schoentgen
- BEAMS (Bio‐, Electro‐ And Mechanical Systems)Université Libre de BruxellesBrusselsBelgium
| | - Marc De Bodt
- Department of Otolaryngology and Head and Neck Surgery, University Rehabilitation Center for Communication DisordersAntwerp University HospitalAntwerpBelgium
- Department of Translational Neurosciences, Faculty of Medicine and Health SciencesUniversity of AntwerpAntwerpBelgium
- Department of Logopaedics and Audiological Sciences, Faculty of Medicine and Health SciencesUniversity of GhentGhentBelgium
| | - Tatiana Dragan
- Department of Radiation Oncology, Head and Neck Unit, Institut Jules BordetUniversité Libre de BruxellesBrusselsBelgium
| | - Antoine Digonnet
- Department of Surgical Oncology, Head and Neck Surgery Unit, Institut Jules BordetUniversité Libre de BruxellesBrusselsBelgium
| | - Nicolas Roper
- Department of Oto‐Rhino‐Laryngology and Head & Neck Surgery, Erasme HospitalUniversité Libre de BruxellesBrusselsBelgium
| | - Dirk Van Gestel
- Department of Radiation Oncology, Head and Neck Unit, Institut Jules BordetUniversité Libre de BruxellesBrusselsBelgium
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Yue K, Lancashire H, de Jager K, Graveston J, Birchall M, Vanhoestenberghe A, Conn A, Rossiter J. An Assistive Coughing Device for Post-Laryngectomy Patients. ACTA ACUST UNITED AC 2021; 3:838-846. [PMID: 34476392 PMCID: PMC8404479 DOI: 10.1109/tmrb.2021.3100798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 04/13/2021] [Accepted: 07/21/2021] [Indexed: 11/09/2022]
Abstract
People who have undergone total laryngectomy typically have difficulties speaking and coughing. Coughing, the protective reflex action where air is rapidly expelled from the lungs to clear the airway, is crucial in everyday life. Insufficiency in coughing can lead to serious chest infections. In this research we present a bionic assistive coughing device (RoboCough) to improve coughing efficacy among laryngectomy patients by increasing pressure and flow rate. RoboCough was designed to mimic the function of the glottis and trachea in the upper respiratory system. Experimental results show a significant increase (t(64) = 4.9, p < 0.0001) in peak cough flow rate and peak cough pressure (t(64) = 12.6, p < 0.0001) among 33 control participants using RoboCough. A pilot study with a smaller cohort of laryngectomy patients shows improvement in peak cough pressure (p = 0.0159) using RoboCough. Preliminary results also show that post-laryngectomy coughs achieved similar peak cough flow (Z = -0.9933, p = 0.32) to the control group’s natural cough. Coughing capabilities could be improved through using RoboCough. Applications of RoboCough include simulation of vocal folds and respiratory conditions, rehabilitation of ineffective coughs from laryngeal and respiratory diseases and as a test-bed for the development of medical devices for respiratory support.
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Affiliation(s)
- Keren Yue
- Bristol Robotics Laboratory and the Department of Engineering MathematicsUniversity of Bristol Bristol BS8 1TR U.K
| | - Henry Lancashire
- Department of Medical Physics and Biomedical EngineeringUniversity College London London WC1E 6BT U.K
| | - Kylie de Jager
- Institute of Orthopaedics and Musculoskeletal Science, University College London London WC1E 6BT U.K
| | - James Graveston
- The Ear Institute, University College London London WC1E 6BT U.K
| | - Martin Birchall
- The Ear Institute, University College London London WC1E 6BT U.K
| | - Anne Vanhoestenberghe
- Institute of Orthopaedics and Musculoskeletal Science, University College London London WC1E 6BT U.K
| | - Andrew Conn
- Bristol Robotics Laboratory and the Department of Mechanical EngineeringUniversity of Bristol Bristol BS8 1TR U.K
| | - Jonathan Rossiter
- Bristol Robotics Laboratory and the Department of Engineering MathematicsUniversity of Bristol Bristol BS8 1TR U.K
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Lulic-Kuryllo T, Thompson CK, Jiang N, Negro F, Dickerson CR. Neural control of the healthy pectoralis major from low-to-moderate isometric contractions. J Neurophysiol 2021; 126:213-226. [PMID: 34107220 DOI: 10.1152/jn.00046.2021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
The pectoralis major critically enables arm movement in several directions. However, its neural control remains unknown. High-density electromyography (HD-sEMG) was acquired from the pectoralis major in two sets of experiments in healthy young adults. Participants performed ramp-and-hold isometric contractions in: adduction, internal rotation, flexion, and horizontal adduction at three force levels: 15%, 25%, and 50% scaled to task-specific maximal voluntary force (MVF). HD-sEMG signals were decomposed into motor unit spike trains using a convolutive blind source separation algorithm and matched across force levels using a motor unit matching algorithm. The mean discharge rate and coefficient of variation were quantified across the hold and compared between 15% and 25% MVF across all tasks, whereas comparisons between 25% and 50% MVF were made where available. Mean motor unit discharge rate was not significantly different between 15% and 25% MVF (all P > 0.05) across all tasks or between 25% and 50% MVF in horizontal adduction (P = 0.11), indicating an apparent saturation across force levels and the absence of rate coding. These findings suggest that the pectoralis major likely relies on motor unit recruitment to increase force, providing first-line evidence of motor unit recruitment in this muscle and paving the way for more deliberate investigations of the pectoralis major involvement in shoulder function.NEW & NOTEWORTHY This work is the first to investigate the relative contribution of rate coding and motor unit recruitment in the pectoralis major muscle in several functionally relevant tasks and across varying force levels in healthy adults. Our results demonstrate the absence of motor unit rate coding with an increase in EMG amplitude with increases in force level in all tasks examined, indicating that the pectoralis major relies on motor unit recruitment to increase force.
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Affiliation(s)
- Tea Lulic-Kuryllo
- Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada
| | - Christopher K Thompson
- Department of Health and Rehabilitation Sciences, Temple University, Philadelphia, Pennsylvania
| | - Ning Jiang
- Department of Systems Design Engineering, University of Waterloo, Waterloo, Ontario, Canada
| | - Francesco Negro
- Department of Clinical and Experimental Sciences, Università degli Studi di Brescia, Brescia, Italy
| | - Clark R Dickerson
- Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada
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Reflex vs. volitional cough differences amongst head and neck cancer survivors characterized by time since treatment and aspiration status. Respir Physiol Neurobiol 2021; 293:103702. [PMID: 34033947 DOI: 10.1016/j.resp.2021.103702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 05/18/2021] [Accepted: 05/20/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND The aim of this study was to investigate differences in reflexive and volitional cough airflows in advanced stage head and neck cancer survivors as it relates to aspiration status and time since treatment. The hypothesis is that those who aspirate several years after treatment completion would demonstrate reduced airflows for all cough parameters compared to those recently status post treatment completion given the known progressive deterioration associated with radiotherapy. METHODS Demographic and airflow data during both reflexive and volitional cough tasks and aspiration status as determined during fiberoptic endoscopic evaluation of swallow function were collected from 33 Head and Neck Cancer (HNC) survivors. RESULTS Omnibus MANOVA for dependent airflow variables and independent variables aspiration status, time since treatment and cough type (reflex or volitional) was significant (F(3,1) = 184, p < 0.000) indicating that peak expiratory flow rates (PEFR) were reduced under reflex (mean PEFR 1.88 SD 0.7) versus volitional (mean PEFR 2.3, SD 0.7) cough types; reduced for aspirators versus non-aspirators (F(2,1) = 4.1, p = 0.04) and reduced for those in the subacute versus chronic phase status post Intensity Modulated Radiotherapy (IMRT) (F(2,1) = 10.05, p = 0.002). CONCLUSION Findings of reduced reflexive compared to volitional cough airflows in head and neck cancer survivors are consistent with those from both healthy and other diseased populations. Additional findings that aspirators demonstrate reduced cough airflows compared to non-aspirators supports the hypothesis. Surprisingly, those recently status post treatment completion show worse cough airflows compared to those remotely status post treatment completion.
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Borders JC, Curtis JA, Sevitz JS, Vanegas-Arroyave N, Troche MS. Immediate Effects of Sensorimotor Training in Airway Protection (smTAP) on Cough Outcomes in Progressive Supranuclear Palsy: A Feasibility Study. Dysphagia 2021; 37:74-83. [PMID: 33515312 DOI: 10.1007/s00455-021-10251-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 01/13/2021] [Indexed: 10/22/2022]
Abstract
Progressive supranuclear palsy (PSP) is a neurodegenerative disease characterized by a high prevalence of dysphagia, cough dysfunction, and resultant aspiration pneumonia. Sensorimotor cough function is important for airway clearance in people with dysphagia. Upregulation of cough has been demonstrated in healthy adults and Parkinson's disease; however, the feasibility of cough rehabilitation in PSP is unknown. We sought to assess feasibility by examining the immediate effects of a novel sensorimotor training in airway protection (smTAP) on upregulation of cough function in PSP. Fifteen individuals with PSP enrolled in this study. Baseline voluntary and reflex cough testing were completed. During smTAP, participants were presented with subthreshold capsaicin and instructed to cough with sufficient intensity to hit a target line (set 25% above baseline reflex peak cough flow) via cough airflow visual biofeedback. Twenty-five repetitions were targeted within a single session. Wilcoxon signed-rank tests compared cough airflow measures between baseline voluntary cough testing, the initial five trials of smTAP, and final five trials. Mean peak expiratory flow rate (PEFR) significantly increased from initial to final smTAP trials (p < 0.001). Fourteen participants increased PEFR, with gains of more than 10% in 11 participants. Variability of PEFR (p = 0.01) and cough expired volume (p = 0.01) significantly decreased across smTAP trials. This study is the first to demonstrate the ability of people with PSP to immediately upregulate cough function, providing preliminary support for the feasibility of cough rehabilitation in this population with this novel treatment approach. Future research examining the effects of multiple sessions of smTAP on cough outcomes is warranted.
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Affiliation(s)
- James C Borders
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, 525 West 120th Street, New York, NY, 10027, USA.
| | - James A Curtis
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, 525 West 120th Street, New York, NY, 10027, USA
| | - Jordanna S Sevitz
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, 525 West 120th Street, New York, NY, 10027, USA
| | - Nora Vanegas-Arroyave
- Division of Movement Disorders, Department of Neurology, Columbia University Medical Center, New York, NY, 10032, USA
| | - Michelle S Troche
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, 525 West 120th Street, New York, NY, 10027, USA
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Lee KK, Davenport PW, Smith JA, Irwin RS, McGarvey L, Mazzone SB, Birring SS. Global Physiology and Pathophysiology of Cough: Part 1: Cough Phenomenology - CHEST Guideline and Expert Panel Report. Chest 2021; 159:282-293. [PMID: 32888932 PMCID: PMC8640837 DOI: 10.1016/j.chest.2020.08.2086] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 08/17/2020] [Accepted: 08/20/2020] [Indexed: 12/12/2022] Open
Abstract
The purpose of this state-of-the-art review is to update the American College of Chest Physicians 2006 guideline on global physiology and pathophysiology of cough. A review of the literature was conducted using PubMed and MEDLINE databases from 1951 to 2019 and using prespecified search terms. We describe the basic phenomenology of cough patterns, behaviors, and morphological features. We update the understanding of mechanical and physiological characteristics of cough, adding a contemporary view of the types of cough and their associated behaviors and sensations. New information about acoustic characteristics is presented, and recent insights into cough triggers and the patient cough hypersensitivity phenotype are explored. Lastly, because the clinical assessment of patients largely focuses on the duration rather than morphological features of cough, we review the morphological features of cough that can be measured in the clinic. This is the first of a two-part update to the American College of Chest Physicians 2006 cough guideline; it provides a more global consideration of cough phenomenology, beyond simply the mechanical aspects of a cough. A greater understanding of the typical features of cough, and their variations, may allow a more informed interpretation of cough measurements and the clinical relevance for patients.
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Affiliation(s)
- Kai K Lee
- School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, London, England
| | - Paul W Davenport
- Department of Physiological Sciences, University of Florida, Gainesville, FL
| | - Jaclyn A Smith
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, England
| | - Richard S Irwin
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, UMass Memorial Medical Center, Worcester, MA
| | - Lorcan McGarvey
- Centre for Experimental Medicine, Department of Medicine, Queen's University Belfast, Belfast, Northern Ireland.
| | - Stuart B Mazzone
- Department of Anatomy and Neuroscience, School of Biomedical Sciences, The University of Melbourne, Melbourne, VIC, Australia.
| | - Surinder S Birring
- Centre for Human and Applied Physiological Sciences, Faculty of Life Sciences and Medicine, King's College London, London, England
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10
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Single and sequential voluntary cough in children with chronic spinal cord injury. Respir Physiol Neurobiol 2020; 285:103604. [PMID: 33358766 DOI: 10.1016/j.resp.2020.103604] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 11/10/2020] [Accepted: 12/17/2020] [Indexed: 11/21/2022]
Abstract
We investigated the impact of spinal cord injury (SCI) on cough capacity in 10 children (Mean ± SD, age 8 ± 4 years) and compared it to 15 typically developing children (age 8 ± 3 years). Participants underwent spirometry, single and sequential cough assessment with surface-electromyography from respiratory muscles. Inspiratory phase duration, inspiratory phase peak flow, inspiratory phase rise time, compression phase duration, expiratory phase rise time, expiratory phase peak airflow (EPPF) and cough volume acceleration (CVA) parameters of single and sequential cough were measured. Root mean square (RMS) values of right pectoralis-major, intercostal, rectus-abdominus (RA), and oblique (OB) muscles were calculated and mean of three trials were compared. The significance criterion was set at P < 0.05. The SCI group produced significantly lower lung volumes, EPPF, CVA, and RMS values of RA and OB during expiratory phases of single and sequential coughs. The decrease in activation in expiratory muscles in the SCI group accounts for the impaired expiratory flow and may contribute to risk of respiratory complications.
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11
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Yawata A, Tsujimura T, Takeishi R, Magara J, Yu L, Inoue M. Comparison of physical properties of voluntary coughing, huffing and swallowing in healthy subjects. PLoS One 2020; 15:e0242810. [PMID: 33270679 PMCID: PMC7714348 DOI: 10.1371/journal.pone.0242810] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 11/09/2020] [Indexed: 11/18/2022] Open
Abstract
Coughing, huffing and swallowing protect the airway from aspiration. This study was conducted to compare the physical properties of voluntary coughing, huffing and swallowing in healthy subjects. Ten healthy men were asked to huff, cough and swallow repeatedly. Electromyograms (EMGs) were recorded from the left side of the external oblique (EO), sternocleidomastoid, suprahyoid (SH) and thyrohyoid muscles. Airflow was recorded using a face mask with two-way non-rebreathing valves. The expiratory velocity of huffing and coughing and the SH EMG of all actions presented high intraclass correlation coefficients (> 0.8). The inspiratory and expiratory velocities did not differ significantly between coughing and huffing. The expiratory acceleration of coughing was significantly higher than that of huffing, whereas the expiratory volume of coughing was significantly smaller than that of huffing. The EO EMG of coughing and huffing were significantly larger than that of swallowing. The EO EMG activity during the expiratory phase was significantly higher than that of the other phases of both coughing and huffing. The SH EMG of coughing and huffing were significantly smaller than that of swallowing. Correlation analysis revealed that the expiratory velocity of coughing was strongly positively correlated with that of huffing. The expiratory volume of huffing was significantly positively correlated with hand grip strength. These results suggest that EO and SH muscle activities during huffing or coughing differ those during swallowing, and huffing and coughing may work similarly in expiratory function.
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Affiliation(s)
- Akiko Yawata
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Chuo-ku, Niigata, Japan
| | - Takanori Tsujimura
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Chuo-ku, Niigata, Japan
| | - Ryosuke Takeishi
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Chuo-ku, Niigata, Japan
| | - Jin Magara
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Chuo-ku, Niigata, Japan
| | - Li Yu
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Makoto Inoue
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Chuo-ku, Niigata, Japan
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12
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Addington WR, Stephens RE, Miller SP. Involuntary cough is superior to voluntary cough for identifying stress urinary incontinence. Cent European J Urol 2020; 72:378-383. [PMID: 32015907 PMCID: PMC6979552 DOI: 10.5173/ceju.2019.1986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 07/18/2019] [Accepted: 10/29/2019] [Indexed: 11/22/2022] Open
Abstract
Introduction Voluntary cough (VC) and the laryngeal expiration reflex (LER) provoke stress urinary incontinence (SUI). The aim of this article is to analyze the effectiveness of these stimuli on the timing of urinary leaks. Material and methods Urodynamic testing using pressure catheters was performed on 123 subjects with history of SUI. The LER was triggered using the induced reflex cough test (iRCT). Each subject was tested with VC and LER and leaked with one or both stimuli. The occurrence and timing of leaks were recorded. Results The peak and average intra-abdominal pressures were 16-19% greater for LER compared to VC. Of the 123 subjects, LER caused leak in 118 (96%), VC in 71 (58%) and both in 66 (54%). For LER compared to VC, leak was more likely to occur during or immediately after the first expiratory effort. The electromyogram for VC and LER were similar. Conclusions The iRCT reliably initiated the LER and triggered SUI more effectively than VC. During VC, the smooth muscle of the internal urethral sphincter (IUS) starts to contract during inspiration, and constriction of the IUS continues into the expiratory phase; this increased urethral tonicity would lessen the likelihood of SUI. We refer to this as the inspiration closure reflex (ICR). With LER the inspiration would not take place, and the first expiratory effort would be against a non-constricted IUS, making leak more likely. Our findings disprove the pressure transmission theory. The internal and external urethral sphincters may both increase urethral closure pressure and resistance.
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Affiliation(s)
| | - Robert E Stephens
- Department of Anatomy, Kansas City University of Medicine and Biosciences, Kansas City, MO, USA
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13
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LoMauro A, Aliverti A. Respiratory muscle activation and action during voluntary cough in healthy humans. J Electromyogr Kinesiol 2019; 49:102359. [PMID: 31568991 DOI: 10.1016/j.jelekin.2019.102359] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 06/20/2019] [Accepted: 09/23/2019] [Indexed: 11/20/2022] Open
Abstract
Cough is a defensive airway reflex consisting of a modified respiratory act which involves the sequential activation of several laryngeal and respiratory muscles. The contraction of the latter results in thoraco-abdominal volume variations in order to provide enough amount of air available, the operating volume (OV), to be expelled. Because both posture and OV could influence muscular activation and thoraco-abdominal displacements during voluntary cough, we aimed to verify if and how they play a role during inspiratory (ICP) and expiratory (ECP) cough phases, in terms of flow, volumes and surface electromyography activity (sEMG). In 10 healthy subjects, we measured sEMG of 7 muscles (scalene, sternocleidomastoid, parasternal, intercostal, diaphragm (assessed at the 8th intercostal space), external abdominal oblique and rectus abdominis) in supine and seated position during cough maneuvers performed at 4 different OV measured by opto-electronic plethismography: total lung capacity (TLC), functional residual capacity and two intermediate volumes. The amplitude of sEMG signals tended to be maximal at TLC (p < 0.005) during ICP in the neck and parasternal muscles and during ECP in abdominal muscles. Postures slightly affected only sEMG of the thoracic muscles. sEMG data were similar (p > 0.05) in the other OV, but cough peak flow increased with OV. Thoraco-abdominal volume variations during cough were unaffected by posture and OV as well, being predominantly thoracic (supine: 60 and 64%; seated: 68 and 69%, respectively during ICP and ECP). Our results suggest that voluntary cough OV or posture do not have an important effect on voluntary cough that seems more likely to be resulting from a motor mechanism that activates a synergetic antagonistic contraction of inspiratory and expiratory muscles leading to a specific thoraco-abdominal pattern, in which the rib cage is the predominant.
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Affiliation(s)
- Antonella LoMauro
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milano, Italy.
| | - Andrea Aliverti
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milano, Italy
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14
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Macedo FS, Rocha AF, Miosso CJ, Mateus SRM. Use of electromyographic signals for characterization of voluntary coughing in humans with and without spinal cord injury—A systematic review. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2019; 24:e1761. [DOI: 10.1002/pri.1761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 09/07/2018] [Accepted: 11/04/2018] [Indexed: 01/16/2023]
Affiliation(s)
- Felipe Soares Macedo
- Graduate Program on Medical SciencesUniversity of Brasília Brasília Brazil
- Graduate Program on Biomedical EngineeringUniversity of Brasília Brasília Brazil
| | - Adson Ferreira Rocha
- Graduate Program on Medical SciencesUniversity of Brasília Brasília Brazil
- Graduate Program on Biomedical EngineeringUniversity of Brasília Brasília Brazil
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15
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Dewaele P, Deffieux X, Villot A, Amarenco G, Billecocq S, Thubert T. Pelvic floor muscle activation in stress urinary incontinent women: Impact of a distraction task. Neurourol Urodyn 2019; 38:950-957. [PMID: 30779380 DOI: 10.1002/nau.23936] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 12/13/2018] [Accepted: 01/09/2019] [Indexed: 11/10/2022]
Abstract
AIMS Our purpose was to explore the involvement of cognition in voluntary and involuntary pelvic floor muscle (PFM) contraction in stress urinary incontinent women. METHODS PFM contraction monitored by surface electromyography (EMG) was measured without a mental distraction task (DT), and with a DT called "paced auditory serial additional test" (PASAT). Forty stress incontinent women performed voluntary contractions of the external anal sphincter (EAS), and reflex EAS contractions induced by means of coughing were studied using the external intercostal muscle (EIC) EMG pattern. RESULTS A DT altered PFM pre-activation when coughing: the reaction time between EIC muscle contraction and EAS contraction (called RT3) was respectively -54.94 ms (IQR -87.12; 3.12) without the PASAT and -3.99 ms (IQR: -47.92; 18.69) with a DT (P = 0.02, Wilcoxon's test). Concerning voluntary contraction, women activated their PFM sooner without than with a DT. CONCLUSION The PASAT altered voluntary and reflex contractions of the PFM in stress urinary incontinent women. Our study suggests that cognition plays a role in urinary pathophysiology. Future studies should investigate rehabilitation programs that consider the role of cognition in stress urinary incontinent women.
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Affiliation(s)
- Pauline Dewaele
- GRC-UPMC 01, GREEN (Group of Clinical Research in Neuro-Urology, University Pierre and Marie Curie), Paris, France.,APHP, Hopital Antoine Béclère, Service de gynécologie obstétrique et biologie de la reproduction, Clamart, France
| | - Xavier Deffieux
- GRC-UPMC 01, GREEN (Group of Clinical Research in Neuro-Urology, University Pierre and Marie Curie), Paris, France.,APHP, Hopital Antoine Béclère, Service de gynécologie obstétrique et biologie de la reproduction, Clamart, France
| | - Anne Villot
- GRC-UPMC 01, GREEN (Group of Clinical Research in Neuro-Urology, University Pierre and Marie Curie), Paris, France
| | - Gérard Amarenco
- GRC-UPMC 01, GREEN (Group of Clinical Research in Neuro-Urology, University Pierre and Marie Curie), Paris, France.,Neuro-Urology Department, Tenon Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Sylvie Billecocq
- GRC-UPMC 01, GREEN (Group of Clinical Research in Neuro-Urology, University Pierre and Marie Curie), Paris, France.,Cabinet de rééducation périnéale, Paris, France
| | - Thibault Thubert
- GRC-UPMC 01, GREEN (Group of Clinical Research in Neuro-Urology, University Pierre and Marie Curie), Paris, France.,Centre Hospitalier Universitaire de Nantes, Hôtel Dieu, Service de Gynécologie Obstétrique Nantes, Nantes, France
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16
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McGuinness K, Ward K, Reilly CC, Morris J, Smith JA. Muscle activation and sound during voluntary single coughs and cough peals in healthy volunteers: Insights into cough intensity. Respir Physiol Neurobiol 2018; 257:42-50. [DOI: 10.1016/j.resp.2018.02.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 02/13/2018] [Accepted: 02/27/2018] [Indexed: 11/26/2022]
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17
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Reyes A, Castillo A, Castillo J, Cornejo I. The effects of respiratory muscle training on peak cough flow in patients with Parkinson's disease: a randomized controlled study. Clin Rehabil 2018; 32:1317-1327. [PMID: 29756459 DOI: 10.1177/0269215518774832] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To compare the effects of an inspiratory versus and expiratory muscle-training program on voluntary and reflex peak cough flow in patients with Parkinson disease. DESIGN A randomized controlled study. SETTING Home-based training program. PARTICIPANTS In all, 40 participants with diagnosis of Parkinson's disease were initially recruited in the study and randomly allocated to three study groups. Of them, 31 participants completed the study protocol (control group, n = 10; inspiratory training group, n = 11; and expiratory training group, n = 10) Intervention: The inspiratory and expiratory group performed a home-based inspiratory and expiratory muscle-training program, respectively (five sets of five repetitions). Both groups trained six times a week for two months using a progressively increased resistance. The control group performed expiratory muscle training using the same protocol and a fixed resistance. MAIN MEASURES Spirometric indices, maximum inspiratory pressure, maximum expiratory pressure, and peak cough flow during voluntary and reflex cough were assessed before and at two months after training. RESULTS The magnitude of increase in maximum expiratory pressure ( d = 1.40) and voluntary peak cough flow ( d = 0.89) was greater for the expiratory muscle-training group in comparison to the control group. Reflex peak cough flow had a moderate effect ( d = 0.27) in the expiratory group in comparison to the control group. Slow vital capacity ( d = 0.13) and forced vital capacity ( d = 0.02) had trivial effects in the expiratory versus the control group. CONCLUSIONS Two months of expiratory muscle-training program was more beneficial than inspiratory muscle-training program for improving maximum expiratory pressure and voluntary peak cough flow in patients with Parkinson's disease.
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Affiliation(s)
- Alvaro Reyes
- 1 Escuela de Kinesiologia, Facultad de Ciencias de la Rehabilitacion, Universidad Andres Bello, Santiago, Chile
| | - Adrián Castillo
- 2 Carrera de Fonoaudiologia, Departamento Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Javiera Castillo
- 3 Escuela de Fonoaudiologia, Facultad de Ciencias, Universidad Mayor, Santiago, Chile
| | - Isabel Cornejo
- 4 Carrera de Kinesiologia, Facultad de Ciencias de la Salud, Universidad San Sebastián, Santiago, Chile
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18
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Banus MS, Birchall MA, Graveston JA. Developing control algorithms of a voluntary cough for an artificial bioengineered larynx using surface electromyography of chest muscles: A prospective cohort study. Clin Otolaryngol 2018; 43:562-566. [PMID: 29069534 DOI: 10.1111/coa.13022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVE This prospective cohort study investigates the prediction of a voluntary cough using surface electromyography (EMG) of intercostal and diaphragm muscles, to develop control algorithms for an EMG-controlled artificial larynx. SETTING The Ear Institute, London. MAIN OUTCOME MEASURES Electromyography onset compared to voluntary cough exhalation onset and to 100 ms (to give the artificial larynx the time to close the bioengineered vocal cords) before voluntary cough exhalation onset, in twelve healthy participants. RESULTS In the 189 EMG of intercostal muscle-detected voluntary coughs, 172 coughs (91% CI 70-112) were detected before onset of cough exhalation and 128 coughs (67.6% CI 33.7-101.7) 100 ms before onset of cough exhalation. In the 158 EMG of diaphragm muscle-detected voluntary coughs, 149 coughs (94.3% CI 76.3-112.3) were detected before onset of cough exhalation and 102 coughs (64.6% CI 26.6-102.6) 100 ms before onset of cough exhalation. More coughs were detected before onset of cough exhalation when combining EMG activity of intercostal and diaphragm muscles and comparing this to intercostal muscle activity alone (183 coughs [96.8% CI 83.8-109.8] vs 172 coughs, P = .0294). When comparing the mentioned combination to diaphragm muscle activity alone, the higher percentage of detected coughs before cough exhalation onset was not found to be significant (183 coughs vs 149 coughs, P = .295). In addition, more coughs were detected 100 ms before onset of cough exhalation with the mentioned combination of EMG activity and comparing this to intercostal muscles alone (149 coughs [78.8% CI 48.8-108.8] vs 128 coughs, P = .0198) and to diaphragm muscles alone (149 coughs vs 102 coughs, P = .0038). CONCLUSIONS Most voluntary coughs can be predicted based on combined EMG signals of intercostal and diaphragm muscles, and therefore, these two muscle groups will be useful in controlling the bioengineered vocal cords within the artificial larynx during a voluntary cough.
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Affiliation(s)
- M S Banus
- Department of Otolaryngology, Head and Neck surgery, The Ear Institute, University College of London, London, UK
| | - M A Birchall
- Department of Otolaryngology, Head and Neck surgery, The Ear Institute, University College of London, London, UK
| | - J A Graveston
- Department of Otolaryngology, Head and Neck surgery, The Ear Institute, University College of London, London, UK
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19
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Mills C, Jones R, Huckabee ML. Measuring voluntary and reflexive cough strength in healthy individuals. Respir Med 2017; 132:95-101. [DOI: 10.1016/j.rmed.2017.09.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 09/04/2017] [Accepted: 09/25/2017] [Indexed: 01/03/2023]
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20
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Cavallari P, Bolzoni F, Esposti R, Bruttini C. Cough-Anal Reflex May Be the Expression of a Pre-Programmed Postural Action. Front Hum Neurosci 2017; 11:475. [PMID: 29021750 PMCID: PMC5624195 DOI: 10.3389/fnhum.2017.00475] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 09/12/2017] [Indexed: 01/23/2023] Open
Abstract
When coughing, an involuntary contraction of the external anal sphincter occurs, in order to prevent unwanted leakages or sagging of the pelvis muscular wall. Literature originally described such cough-anal response as a reflex elicited by cough, therefore identifying a precise cause-effect relationship. However, recent studies report that the anal contraction actually precedes the rise in abdominal pressure during cough expiratory effort, so that the sphincter activity should be pre-programmed. In recent years, an important family of pre-programmed muscle activities has been well documented to precede voluntary movements: these anticipatory actions play a fundamental role in whole body and segmental postural control, hence they are referred to as anticipatory postural adjustments (APAs). On these basis, we searched in literature for similarities between APAs and the cough-anal response, observing that both follow the same predictive homeostatic principle, namely that anticipatory collateral actions are needed to prevent the unwanted mechanical consequences induced by the primary movement. We thus propose that the cough-anal response also belongs to the family of pre-programmed actions, as it may be interpreted as an APA acting on the abdominal-thoracic compartment; in other words, the cough-anal response may actually be an Anticipatory Sphincter Adjustment, the visceral counterpart of APAs.
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Affiliation(s)
- Paolo Cavallari
- Human Motor Control and Posture Lab, Section Human Physiology of the Department of Pathophysiology and Transplantation, Università degli Studi di MilanoMilan, Italy
| | - Francesco Bolzoni
- Human Motor Control and Posture Lab, Section Human Physiology of the Department of Pathophysiology and Transplantation, Università degli Studi di MilanoMilan, Italy
| | - Roberto Esposti
- Human Motor Control and Posture Lab, Section Human Physiology of the Department of Pathophysiology and Transplantation, Università degli Studi di MilanoMilan, Italy
| | - Carlo Bruttini
- Human Motor Control and Posture Lab, Section Human Physiology of the Department of Pathophysiology and Transplantation, Università degli Studi di MilanoMilan, Italy
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21
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Steier J, Cade N, Walker B, Moxham J, Jolley C. Observational Study of Neural Respiratory Drive During Sleep at High Altitude. High Alt Med Biol 2017. [PMID: 28628341 DOI: 10.1089/ham.2016.0097] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Steier, Joerg, Nic Cade, Ben Walker, John Moxham, and Caroline Jolley. Observational study of neural respiratory drive during sleep at high altitude. High Alt Med Biol. 18:242-248, 2017. AIMS Ventilation at altitude changes due to altered levels of pO2, pCO2 and the effect on blood pH. Nocturnal ventilation is particularly exposed to these changes. We hypothesized that an increasing neural respiratory drive (NRD) is associated with the severity of sleep-disordered breathing at altitude. METHODS Mountaineers were studied at sea level (London, United Kingdom), and at altitude at the Aconcagua (Andes, Argentina). NRD was measured as electromyogram of the diaphragm (EMGdi) overnight by a transesophageal multi-electrode catheter; results were reported for sea level, 3,380 m, 4,370 m, and 5,570 m. RESULTS Four healthy subjects (3 men, age 31(3)years, body mass index 23.6(0.9)kg/m2, neck circumference 37.0(2.7)cm, forced expiratory volume in 1 second 111.8(5.1)%predicted, and forced vital capacity 115.5(6.3)%predicted) were studied. No subject had significant sleep abnormalities at sea level. Time to ascent to 3,380 m was 1 day, to 4,370 m was 5 days, and the total nights at altitude were 21 days. The oxygen desaturation index (4% oxygen desaturation index [ODI] 0.8(0.4), 22.0 (7.2), 61.4 (26.9), 144.9/hour, respectively) and the EMGdi (5.2 (1.9), 12.8 (5.1), 14.1 (3.4), 18.5%, respectively) increased with the development of periodic breathing at altitude, whereas the average SpO2 declined (97.5 (1.3), 84.8 (0.5), 81.0 (4.1), 68.5%, respectively). The average EMGdi correlated well with the 4%ODI (r = 0.968, p = 0.032). CONCLUSION NRD sleep increases at altitude in relation to the severity of periodic breathing.
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Affiliation(s)
- Joerg Steier
- 1 Faculty of Life Sciences and Medicine, King's College London , London, United Kingdom .,2 Lane Fox Respiratory Unit and Sleep Disorders Centre, Guy's and St. Thomas' NHS Foundation , London, United Kingdom
| | - Nic Cade
- 3 Synthetic and Systems Biochemistry of the Microtubule Cytoskeleton Laboratory, Francis Crick Institute , London, United Kingdom
| | - Ben Walker
- 1 Faculty of Life Sciences and Medicine, King's College London , London, United Kingdom
| | - John Moxham
- 1 Faculty of Life Sciences and Medicine, King's College London , London, United Kingdom
| | - Caroline Jolley
- 1 Faculty of Life Sciences and Medicine, King's College London , London, United Kingdom
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22
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Laghi F, Maddipati V, Schnell T, Langbein WE, Tobin MJ. Determinants of cough effectiveness in patients with respiratory muscle weakness. Respir Physiol Neurobiol 2017; 240:17-25. [DOI: 10.1016/j.resp.2017.02.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 01/23/2017] [Accepted: 02/09/2017] [Indexed: 10/20/2022]
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23
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Lee KK, Matos S, Ward K, Rafferty GF, Moxham J, Evans DH, Birring SS. Sound: a non-invasive measure of cough intensity. BMJ Open Respir Res 2017; 4:e000178. [PMID: 28725446 PMCID: PMC5501240 DOI: 10.1136/bmjresp-2017-000178] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 03/28/2017] [Accepted: 03/29/2017] [Indexed: 11/30/2022] Open
Abstract
Introduction Cough intensity is an important determinant of cough severity reported by patients. Cough sound analysis has been widely validated for the measurement of cough frequency but few studies have validated its use in the assessment of cough strength. We investigated the relationship between cough sound and physiological measures of cough strength. Methods 32 patients with chronic cough and controls underwent contemporaneous measurements of voluntary cough sound, flow and oesophageal pressure. Sound power, peak energy, rise-time, duration, peak-frequency, bandwidth and centroid-frequency were assessed and compared with physiological measures. The relationship between sound and subjective cough strength Visual Analogue Score (VAS), the repeatability of cough sounds and the effect of microphone position were also assessed. Results Sound power and energy correlated strongly with cough flow (median Spearman’s r=0.87–0.88) and oesophageal pressure (median Spearman’s r=0.89). Sound power and energy correlated strongly with cough strength VAS (median Spearman’s r=0.84–0.86) and were highly repeatable (intraclass correlation coefficient=0.93–0.94) but both were affected by change in microphone position. Conclusions Cough sound power and energy correlate strongly with physiological measures and subjective perception of cough strength. Power and energy are highly repeatable measures but the microphone position should be standardised. Our findings support the use of cough sound as an index of cough strength.
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Affiliation(s)
- Kai K Lee
- Division of Asthma, Allergy and Lung Biology, King's College London, London, UK.,Department of Respiratory Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | - Sergio Matos
- Institute of Electronics and Telematics Engineering, University of Aveiro, Aveiro, Portugal
| | - Katie Ward
- Division of Asthma, Allergy and Lung Biology, King's College London, London, UK
| | - Gerrard F Rafferty
- Division of Asthma, Allergy and Lung Biology, King's College London, London, UK
| | - John Moxham
- Division of Asthma, Allergy and Lung Biology, King's College London, London, UK.,Department of Respiratory Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | - David H Evans
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Surinder S Birring
- Division of Asthma, Allergy and Lung Biology, King's College London, London, UK.,Department of Respiratory Medicine, King's College Hospital NHS Foundation Trust, London, UK
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24
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Brandimore AE, Hegland KW, Okun MS, Davenport PW, Troche MS. Voluntary upregulation of reflex cough is possible in healthy older adults and Parkinson's disease. J Appl Physiol (1985) 2017; 123:19-26. [PMID: 28360120 DOI: 10.1152/japplphysiol.00612.2016] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 02/24/2017] [Accepted: 03/22/2017] [Indexed: 11/22/2022] Open
Abstract
Cough is an airway-protective mechanism that serves to detect and forcefully eject aspirate material. Existing research has identified the ability of healthy young adults to suppress or modify cough motor output based on external cueing. However, no study has evaluated the ability of people with Parkinson's disease (PD) and healthy older adults (HOAs) to upregulate cough motor output. The goal of this study was to evaluate the ability of people with PD and healthy age-matched controls (HOAs) to upregulate reflex and voluntary cough function volitionally with verbal instruction and visual biofeedback of airflow targets. Sixteen participants with PD and twenty-eight HOAs (56-83 yr old) were recruited for this study. Experimental procedures used spirometry to evaluate 1) baseline reflex cough (evoked with capsaicin) and voluntary sequential cough and 2) reflex and voluntary cough with upregulation biofeedback. Cough airflow was recorded and repeated-measures ANOVA was used to analyze differences in cough airflow parameters. Cough peak expiratory airflow rate and cough expired volume were significantly greater in the cueing condition for both induced reflex (P < 0.001) and voluntary cough (P < 0.001) compared with baseline measures. This is the first study to demonstrate the ability of people with PD and HOAs to upregulate induced reflex and voluntary cough motor output volitionally. These results support the development of studies targeting improved cough effectiveness in patients with airway-protective deficits.NEW & NOTEWORTHY Aspiration pneumonia is a leading cause of death in Parkinson's disease (PD) and results from concurrent dysphagia and dystussia (cough dysfunction). This is the first study to demonstrate that people with PD and healthy age-matched controls can volitionally upregulate induced reflex and voluntary cough effectiveness when presented with novel cueing strategies. Thus targeting upregulation of cough effectiveness via biofeedback may be a viable way to enhance airway protection in people with PD.
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Affiliation(s)
- Alexandra E Brandimore
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, New York.,Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, Florida.,Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville, Florida
| | - Karen W Hegland
- Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, Florida.,Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville, Florida.,Department of Neurology, University of Florida, Gainesville, Florida; and
| | - Michael S Okun
- Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, Florida.,Department of Neurology, University of Florida, Gainesville, Florida; and
| | - Paul W Davenport
- Department of Physiological Sciences, University of Florida, Gainesville, Florida
| | - Michelle S Troche
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, New York; .,Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, Florida
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25
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Fujiwara K, Kawamoto K, Shimizu Y, Fukuhara T, Koyama S, Kataoka H, Kitano H, Takeuchi H. A novel reflex cough testing device. BMC Pulm Med 2017; 17:19. [PMID: 28100202 PMCID: PMC5242037 DOI: 10.1186/s12890-017-0365-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 01/10/2017] [Indexed: 12/18/2022] Open
Abstract
Background The reflex cough test is useful for detecting silent aspiration, a risk factor for aspiration pneumonia. However, assessing the risk of aspiration pneumonia requires measuring not only the cough reflex but also cough strength. Currently, no reflex cough testing device is available that can directly measure reflex cough strength. We therefore developed a new testing device that can easily and simultaneously measure cough strength and the time until the cough reflex, and verified whether screening with this new instrument is feasible for evaluating the risk of aspiration pneumonia. Methods This device consists of a special pipe with a double lumen, a nebulizer, and an electronic spirometer. We used a solution of prescription-grade L-tartaric acid to initiate the cough reflex. The solution was inhaled through a mouthpiece as a microaerosol produced by an ultrasonic nebulizer. The peak cough flow (PCF) of the induced cough was measured with the spirometer. The 70 patients who participated in this study comprised 49 patients without a history of pneumonia (group A), 21 patients with a history of pneumonia (group B), and 10 healthy volunteers (control group). Results With the novel device, PCF and time until cough reflex could be measured without adverse effects. The PCF values were 118.3 ± 64.0 L/min, 47.7 ± 38.5 L/min, and 254.9 ± 83.8 L/min in group A, group B, and the control group, respectively. The PCF of group B was significantly lower than that of group A and the control group (p < 0.0001), while that of group B was significantly lower than that of the control group (p < 0.0001). The time until the cough reflex was 4.2 ± 5.9 s, 7.0 ± 7.0 s, and 1 s in group A, group B, and the control group, respectively. This duration was significantly longer for groups A and B than for the control group (A: p < 0.001, B: p < 0.001), but there was no significant difference between groups A and B (p = 0.0907). Conclusion Our newly developed device can easily and simultaneously measure the time until the cough reflex and the strength of involuntary coughs for assessment of patients at risk of aspiration pneumonia. Electronic supplementary material The online version of this article (doi:10.1186/s12890-017-0365-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kazunori Fujiwara
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, Tottori University, 36-1, Nishimachi, Yonago, 683-8504, Japan.
| | - Katsuyuki Kawamoto
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, Tottori University, 36-1, Nishimachi, Yonago, 683-8504, Japan
| | - Yoko Shimizu
- Department of Rehabilitation, Tottori University Hospital, 36-1, Nishimachi, Yonago, 683-8504, Japan
| | - Takahiro Fukuhara
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, Tottori University, 36-1, Nishimachi, Yonago, 683-8504, Japan
| | - Satoshi Koyama
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, Tottori University, 36-1, Nishimachi, Yonago, 683-8504, Japan
| | - Hideyuki Kataoka
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, Tottori University, 36-1, Nishimachi, Yonago, 683-8504, Japan
| | - Hiroya Kitano
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, Tottori University, 36-1, Nishimachi, Yonago, 683-8504, Japan
| | - Hiromi Takeuchi
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, Tottori University, 36-1, Nishimachi, Yonago, 683-8504, Japan
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Kutchak FM, Debesaitys AM, Rieder MDM, Meneguzzi C, Skueresky AS, Forgiarini Junior LA, Bianchin MM. Reflex cough PEF as a predictor of successful extubation in neurological patients. J Bras Pneumol 2016; 41:358-64. [PMID: 26398756 PMCID: PMC4635956 DOI: 10.1590/s1806-37132015000004453] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Objective: To evaluate the use of reflex cough PEF as a predictor of successful extubation in neurological patients who were candidates for weaning from mechanical ventilation. Methods: This was a cross-sectional study of 135 patients receiving mechanical ventilation for more than 24 h in the ICU of Cristo Redentor Hospital, in the city of Porto Alegre, Brazil. Reflex cough PEF, the rapid shallow breathing index, MIP, and MEP were measured, as were ventilatory, hemodynamic, and clinical parameters. Results: The mean age of the patients was 47.8 ± 17 years. The extubation failure rate was 33.3%. A reflex cough PEF of < 80 L/min showed a relative risk of 3.6 (95% CI: 2.0-6.7), and the final Glasgow Coma Scale score showed a relative risk of 0.64 (95% CI: 0.51-0.83). For every 1-point increase in a Glasgow Coma Scale score of 8, there was a 36% reduction in the risk of extubation failure. Conclusions: Reflex cough PEF and the Glasgow Coma Scale score are independent predictors of extubation failure in neurological patients admitted to the ICU.
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Affiliation(s)
| | | | | | | | | | | | - Marino Muxfeldt Bianchin
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, BR
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Lee KK, Ward K, Rafferty GF, Moxham J, Birring SS. The Intensity of Voluntary, Induced, and Spontaneous Cough. Chest 2016; 148:1259-1267. [PMID: 26134718 DOI: 10.1378/chest.15-0138] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND The intensity of cough is an important determinant of cough severity. Few studies have quantified cough intensity in patients with chronic cough with objective measures. We investigated the intensity of voluntary, induced, and spontaneous cough in patients with chronic cough and healthy control subjects. METHODS Patients with chronic cough and control subjects underwent physiologic assessment of the intensity of maximum voluntary, capsaicin-induced, and spontaneous cough. Assessments included measurement of gastric pressure (Pga) and esophageal pressure (Pes) during cough, peak cough flow (PCF), expiratory muscle strength (twitch gastric pressure [TwPga]), and cough compression phase duration (CPD). Subjective perception of cough intensity was assessed using a visual analog scale (VAS). RESULTS Pes, Pga, and PCF during maximum voluntary cough were significantly greater in patients with chronic cough compared with control subjects (P = .003-.042). There was no difference in TwPga between patients and control subjects. CPD was increased in female patients compared with control subjects (mean ± SD, 0.50 ± 0.22 s vs 0.28 ± 0.17 s; P = .007). Mean ± SD Pes during spontaneous cough was comparable to induced cough (128 ± 28 cm H2O vs 122 ± 37 cm H2O, P = .686) but less than maximum voluntary cough (170 ± 46 cm H2O, P = .020). Median within-subject correlation coefficients between cough intensity VAS and Pes, Pga, and PCF were r = 0.82 to 0.86. CONCLUSIONS Maximum voluntary cough intensity was increased in patients with chronic cough compared with control subjects. There was no significant difference in expiratory muscle contractility. Further studies should evaluate the compressive phase of cough in more detail. Physiologic measures of cough intensity correlated strongly with subjective perception of intensity in patients with chronic cough and may be relevant objective outcome measures for clinical studies.
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Affiliation(s)
- Kai K Lee
- Division of Asthma, Allergy and Lung Biology, King's College London, King's Health Partners, London, England
| | - Katie Ward
- Division of Asthma, Allergy and Lung Biology, King's College London, King's Health Partners, London, England
| | - Gerrard F Rafferty
- Division of Asthma, Allergy and Lung Biology, King's College London, King's Health Partners, London, England
| | - John Moxham
- Division of Asthma, Allergy and Lung Biology, King's College London, King's Health Partners, London, England
| | - Surinder S Birring
- Division of Asthma, Allergy and Lung Biology, King's College London, King's Health Partners, London, England.
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Jang SH, Bang HS. Effect of thoracic and cervical joint mobilization on pulmonary function in stroke patients. J Phys Ther Sci 2016; 28:257-60. [PMID: 26957769 PMCID: PMC4756015 DOI: 10.1589/jpts.28.257] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 10/16/2015] [Indexed: 11/25/2022] Open
Abstract
[Purpose] This study aimed to conduct thoracic and cervical mobilization in stroke
patients and determine its effects on respiratory function. [Subjects and Methods]
Twenty-one stroke patients were studied. Subjects were divided into a control group
(control group, n=11) who did not undergo thoracic and cervical joint mobilization, and an
experimental group (thoracic and cervical mobilization group, n=10) who underwent thoracic
and cervical joint mobilization. Forced vital capacity and forced expiratory volume in the
first second, well-known indicators of respiratory capabilities, were measured. Peak cough
flow was measured as an indicator of cough capability. [Results] After the exercise,
respiratory function in the thoracic and cervical mobilization group showed statistically
significant improvements demonstrated by increases in forced vital capacity, forced
expiratory volume in the first second, and peak cough flow. [Conclusion] The findings
indicate that thoracic and cervical mobilization can improve the thoracic movements of
stroke patients resulting in improved pulmonary function.
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Affiliation(s)
- Sang-Hun Jang
- Department of Physical Therapy, Gimcheon University, Republic of Korea
| | - Hyun-Soo Bang
- Department of Physical Therapy, Gimcheon University, Republic of Korea
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Turner RD. Cough Intensity: Is Respiratory Muscle Activation Important and Does It Relate to Symptoms? Chest 2016; 149:285-6. [PMID: 26757293 DOI: 10.1016/j.chest.2015.09.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 09/15/2015] [Indexed: 10/22/2022] Open
Affiliation(s)
- Richard D Turner
- Department of Respiratory Medicine, Homerton University Hospital NHS Foundation Trust, London, England.
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Lee KK, Ward K, Rafferty GF, Moxham J, Birring SS. Response. Chest 2016; 149:286-7. [PMID: 26757294 DOI: 10.1016/j.chest.2015.09.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 09/29/2015] [Indexed: 10/22/2022] Open
Affiliation(s)
- Kai K Lee
- King's College London, Division of Asthma, Allergy and Lung Biology, King's Health Partners, London, England
| | - Katie Ward
- King's College London, Division of Asthma, Allergy and Lung Biology, King's Health Partners, London, England
| | - Gerrard F Rafferty
- King's College London, Division of Asthma, Allergy and Lung Biology, King's Health Partners, London, England
| | - John Moxham
- King's College London, Division of Asthma, Allergy and Lung Biology, King's Health Partners, London, England
| | - Surinder S Birring
- King's College London, Division of Asthma, Allergy and Lung Biology, King's Health Partners, London, England.
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Brandimore AE, Troche MS, Huber JE, Hegland KW. Respiratory kinematic and airflow differences between reflex and voluntary cough in healthy young adults. Front Physiol 2015; 6:284. [PMID: 26500560 PMCID: PMC4598583 DOI: 10.3389/fphys.2015.00284] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 09/24/2015] [Indexed: 02/06/2023] Open
Abstract
Background: Cough is a defensive behavior that can be initiated in response to a stimulus in the airway (reflexively), or on command (voluntarily). There is evidence to suggest that physiological differences exist between reflex and voluntary cough; however, the output (mechanistic and airflow) differences between the cough types are not fully understood. Therefore, the aims of this study were to determine the lung volume, respiratory kinematic, and airflow differences between reflex and voluntary cough in healthy young adults. Methods: Twenty-five participants (14 female; 18–29 years) were recruited for this study. Participants were evaluated using respiratory inductance plethysmography calibrated with spirometry. Experimental procedures included: (1) respiratory calibration, (2) three voluntary sequential cough trials, and (3) three reflex cough trials induced with 200 μM capsaicin. Results: Lung volume initiation (LVI; p = 0.003) and lung volume excursion (LVE; p < 0.001) were significantly greater for voluntary cough compared to reflex cough. The rib cage and abdomen significantly influenced LVI for voluntary cough (p < 0.001); however, only the rib cage significantly impacted LVI for reflex cough (p < 0.001). LVI significantly influenced peak expiratory flow rate (PEFR) for voluntary cough (p = 0.029), but not reflex cough (p = 0.610). Discussion: Production of a reflex cough results in significant mechanistic and airflow differences compared to voluntary cough. These findings suggest that detection of a tussigenic stimulus modifies motor aspects of the reflex cough behavior. Further understanding of the differences between reflex and voluntary cough in older adults and in persons with dystussia (cough dysfunction) will be essential to facilitate the development of successful cough treatment paradigms.
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Affiliation(s)
- Alexandra E Brandimore
- Department of Speech, Language, and Hearing Sciences, University of Florida Gainesville, FL, USA ; Malcom Randall VA Medical Center, Brain Rehabilitation Research Center Gainesville, FL, USA
| | - Michelle S Troche
- Department of Biobehavioral Sciences, Teachers College Columbia University New York, NY, USA
| | - Jessica E Huber
- Department of Speech, Language, and Hearing Sciences, Purdue University West Lafayette, IN, USA
| | - Karen W Hegland
- Department of Speech, Language, and Hearing Sciences, University of Florida Gainesville, FL, USA
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Messaggi-Sartor M, Guillen-Solà A, Depolo M, Duarte E, Rodríguez DA, Barrera MC, Barreiro E, Escalada F, Orozco-Levi M, Marco E. Inspiratory and expiratory muscle training in subacute stroke: A randomized clinical trial. Neurology 2015; 85:564-72. [PMID: 26180145 DOI: 10.1212/wnl.0000000000001827] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 04/15/2015] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To assess the effectiveness, feasibility, and safety of short-term inspiratory and expiratory muscle training (IEMT) in subacute stroke patients. METHODS Within 2 weeks of stroke onset, 109 patients with a first ischemic stroke event were randomly assigned to the IEMT (n = 56) or sham IEMT (n = 53) study group. The IEMT consisted of 5 sets of 10 repetitions, twice a day, 5 days per week for 3 weeks, at a training workload equivalent to 30% of maximal respiratory pressures. Patients and researchers assessing outcome variables were blinded to the assigned study group. The main outcome was respiratory muscle strength assessed by maximal inspiratory and expiratory pressures (PImax, PEmax). Respiratory complications at 6 months were also recorded. RESULTS Both groups improved respiratory muscle strength during the study. IEMT was associated with significantly improved %PImax and %PEmax: effect size d = 0.74 (95% confidence interval [CI] 0.28-1.20) and d = 0.56 (95% CI 0.11-1.02), respectively. No significant training effect was observed for peripheral muscle strength. Respiratory complications at 6 months occurred more frequently in the sham group (8 vs 2, p = 0.042), with an absolute risk reduction of 14%. The number needed to treat to prevent one lung infection event over a follow-up of 6 months was 7. No major adverse events or side effects were observed. CONCLUSION IEMT induces significant improvement in inspiratory and expiratory muscle strength and could potentially offer an additional therapeutic tool aimed to reduce respiratory complications at 6 months in stroke patients. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that short-term training may have the potential to improve respiratory muscle strength in patients with subacute stroke.
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Affiliation(s)
- Monique Messaggi-Sartor
- From the Rehabilitation Research Group (M.M.-S., A.G.-S., E.D., M.-C.B., F.E., E.M.) and the Muscle and Respiratory System Research Unit (URMAR) (D.A.R., E.B.), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM); the Physical Medicine and Rehabilitation Department (M.M.-S., A.G.-S., M.D., E.D., M.-C.B., F.E., E.M.), Parc de Salut Mar (Hospital del Mar, Hospital de l'Esperança); the School of Medicine (A.G.-S., E.D., D.A.R., F.E., E.M.), Universitat Autònoma de Barcelona; the Respiratory Medicine Department (D.A.R., E.B., M.O.-L.), Hospital del Mar; the Department of Health Sciences (CEXS) (D.A.R., E.B., M.O.-L.), Universitat Pompeu i Fabra, Barcelona; and the Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES) (D.A.R., E.B.), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Anna Guillen-Solà
- From the Rehabilitation Research Group (M.M.-S., A.G.-S., E.D., M.-C.B., F.E., E.M.) and the Muscle and Respiratory System Research Unit (URMAR) (D.A.R., E.B.), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM); the Physical Medicine and Rehabilitation Department (M.M.-S., A.G.-S., M.D., E.D., M.-C.B., F.E., E.M.), Parc de Salut Mar (Hospital del Mar, Hospital de l'Esperança); the School of Medicine (A.G.-S., E.D., D.A.R., F.E., E.M.), Universitat Autònoma de Barcelona; the Respiratory Medicine Department (D.A.R., E.B., M.O.-L.), Hospital del Mar; the Department of Health Sciences (CEXS) (D.A.R., E.B., M.O.-L.), Universitat Pompeu i Fabra, Barcelona; and the Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES) (D.A.R., E.B.), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Marina Depolo
- From the Rehabilitation Research Group (M.M.-S., A.G.-S., E.D., M.-C.B., F.E., E.M.) and the Muscle and Respiratory System Research Unit (URMAR) (D.A.R., E.B.), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM); the Physical Medicine and Rehabilitation Department (M.M.-S., A.G.-S., M.D., E.D., M.-C.B., F.E., E.M.), Parc de Salut Mar (Hospital del Mar, Hospital de l'Esperança); the School of Medicine (A.G.-S., E.D., D.A.R., F.E., E.M.), Universitat Autònoma de Barcelona; the Respiratory Medicine Department (D.A.R., E.B., M.O.-L.), Hospital del Mar; the Department of Health Sciences (CEXS) (D.A.R., E.B., M.O.-L.), Universitat Pompeu i Fabra, Barcelona; and the Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES) (D.A.R., E.B.), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Esther Duarte
- From the Rehabilitation Research Group (M.M.-S., A.G.-S., E.D., M.-C.B., F.E., E.M.) and the Muscle and Respiratory System Research Unit (URMAR) (D.A.R., E.B.), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM); the Physical Medicine and Rehabilitation Department (M.M.-S., A.G.-S., M.D., E.D., M.-C.B., F.E., E.M.), Parc de Salut Mar (Hospital del Mar, Hospital de l'Esperança); the School of Medicine (A.G.-S., E.D., D.A.R., F.E., E.M.), Universitat Autònoma de Barcelona; the Respiratory Medicine Department (D.A.R., E.B., M.O.-L.), Hospital del Mar; the Department of Health Sciences (CEXS) (D.A.R., E.B., M.O.-L.), Universitat Pompeu i Fabra, Barcelona; and the Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES) (D.A.R., E.B.), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Diego A Rodríguez
- From the Rehabilitation Research Group (M.M.-S., A.G.-S., E.D., M.-C.B., F.E., E.M.) and the Muscle and Respiratory System Research Unit (URMAR) (D.A.R., E.B.), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM); the Physical Medicine and Rehabilitation Department (M.M.-S., A.G.-S., M.D., E.D., M.-C.B., F.E., E.M.), Parc de Salut Mar (Hospital del Mar, Hospital de l'Esperança); the School of Medicine (A.G.-S., E.D., D.A.R., F.E., E.M.), Universitat Autònoma de Barcelona; the Respiratory Medicine Department (D.A.R., E.B., M.O.-L.), Hospital del Mar; the Department of Health Sciences (CEXS) (D.A.R., E.B., M.O.-L.), Universitat Pompeu i Fabra, Barcelona; and the Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES) (D.A.R., E.B.), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Maria-Camelia Barrera
- From the Rehabilitation Research Group (M.M.-S., A.G.-S., E.D., M.-C.B., F.E., E.M.) and the Muscle and Respiratory System Research Unit (URMAR) (D.A.R., E.B.), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM); the Physical Medicine and Rehabilitation Department (M.M.-S., A.G.-S., M.D., E.D., M.-C.B., F.E., E.M.), Parc de Salut Mar (Hospital del Mar, Hospital de l'Esperança); the School of Medicine (A.G.-S., E.D., D.A.R., F.E., E.M.), Universitat Autònoma de Barcelona; the Respiratory Medicine Department (D.A.R., E.B., M.O.-L.), Hospital del Mar; the Department of Health Sciences (CEXS) (D.A.R., E.B., M.O.-L.), Universitat Pompeu i Fabra, Barcelona; and the Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES) (D.A.R., E.B.), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Esther Barreiro
- From the Rehabilitation Research Group (M.M.-S., A.G.-S., E.D., M.-C.B., F.E., E.M.) and the Muscle and Respiratory System Research Unit (URMAR) (D.A.R., E.B.), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM); the Physical Medicine and Rehabilitation Department (M.M.-S., A.G.-S., M.D., E.D., M.-C.B., F.E., E.M.), Parc de Salut Mar (Hospital del Mar, Hospital de l'Esperança); the School of Medicine (A.G.-S., E.D., D.A.R., F.E., E.M.), Universitat Autònoma de Barcelona; the Respiratory Medicine Department (D.A.R., E.B., M.O.-L.), Hospital del Mar; the Department of Health Sciences (CEXS) (D.A.R., E.B., M.O.-L.), Universitat Pompeu i Fabra, Barcelona; and the Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES) (D.A.R., E.B.), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Ferran Escalada
- From the Rehabilitation Research Group (M.M.-S., A.G.-S., E.D., M.-C.B., F.E., E.M.) and the Muscle and Respiratory System Research Unit (URMAR) (D.A.R., E.B.), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM); the Physical Medicine and Rehabilitation Department (M.M.-S., A.G.-S., M.D., E.D., M.-C.B., F.E., E.M.), Parc de Salut Mar (Hospital del Mar, Hospital de l'Esperança); the School of Medicine (A.G.-S., E.D., D.A.R., F.E., E.M.), Universitat Autònoma de Barcelona; the Respiratory Medicine Department (D.A.R., E.B., M.O.-L.), Hospital del Mar; the Department of Health Sciences (CEXS) (D.A.R., E.B., M.O.-L.), Universitat Pompeu i Fabra, Barcelona; and the Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES) (D.A.R., E.B.), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Mauricio Orozco-Levi
- From the Rehabilitation Research Group (M.M.-S., A.G.-S., E.D., M.-C.B., F.E., E.M.) and the Muscle and Respiratory System Research Unit (URMAR) (D.A.R., E.B.), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM); the Physical Medicine and Rehabilitation Department (M.M.-S., A.G.-S., M.D., E.D., M.-C.B., F.E., E.M.), Parc de Salut Mar (Hospital del Mar, Hospital de l'Esperança); the School of Medicine (A.G.-S., E.D., D.A.R., F.E., E.M.), Universitat Autònoma de Barcelona; the Respiratory Medicine Department (D.A.R., E.B., M.O.-L.), Hospital del Mar; the Department of Health Sciences (CEXS) (D.A.R., E.B., M.O.-L.), Universitat Pompeu i Fabra, Barcelona; and the Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES) (D.A.R., E.B.), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Ester Marco
- From the Rehabilitation Research Group (M.M.-S., A.G.-S., E.D., M.-C.B., F.E., E.M.) and the Muscle and Respiratory System Research Unit (URMAR) (D.A.R., E.B.), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM); the Physical Medicine and Rehabilitation Department (M.M.-S., A.G.-S., M.D., E.D., M.-C.B., F.E., E.M.), Parc de Salut Mar (Hospital del Mar, Hospital de l'Esperança); the School of Medicine (A.G.-S., E.D., D.A.R., F.E., E.M.), Universitat Autònoma de Barcelona; the Respiratory Medicine Department (D.A.R., E.B., M.O.-L.), Hospital del Mar; the Department of Health Sciences (CEXS) (D.A.R., E.B., M.O.-L.), Universitat Pompeu i Fabra, Barcelona; and the Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES) (D.A.R., E.B.), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.
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Birring SS, Spinou A. How best to measure cough clinically. Curr Opin Pharmacol 2015; 22:37-40. [PMID: 25819594 DOI: 10.1016/j.coph.2015.03.003] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 03/03/2015] [Accepted: 03/05/2015] [Indexed: 11/30/2022]
Abstract
It is possible to measure cough by assessing its severity, frequency, intensity, associated urge and its impact on quality of life. Cough severity can simply be assessed with a Visual Analogue Scale. Cough frequency can be assessed objectively with cough frequency monitors. Validated cough monitors include the Leicester Cough Monitor and the VitaloJAK. Cough reflex sensitivity measurement is better used to investigate the mechanisms of action of antitussive medications, rather than assessing efficacy. Health-Related Quality of Life measures are available to assess the impact of cough; they include the validated Leicester Cough Questionnaire and Cough-specific Quality of Life Questionnaire for adult patients. It is best to assess cough with a combination of subjective and objective tools, to capture its wide-ranging impact.
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Affiliation(s)
- Surinder S Birring
- King's College London, Division of Asthma, Allergy and Lung Biology, Denmark Hill Campus, London, UK.
| | - Arietta Spinou
- King's College London, Division of Asthma, Allergy and Lung Biology, Denmark Hill Campus, London, UK
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Ando A, Farrell MJ, Mazzone SB. Cough-related neural processing in the brain: A roadmap for cough dysfunction? Neurosci Biobehav Rev 2014; 47:457-68. [DOI: 10.1016/j.neubiorev.2014.09.018] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 06/29/2014] [Accepted: 09/25/2014] [Indexed: 01/05/2023]
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Wheeler Hegland K, Troche MS, Brandimore AE, Davenport PW, Okun MS. Comparison of voluntary and reflex cough effectiveness in Parkinson's disease. Parkinsonism Relat Disord 2014; 20:1226-30. [PMID: 25246315 PMCID: PMC5450039 DOI: 10.1016/j.parkreldis.2014.09.010] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 09/02/2014] [Accepted: 09/04/2014] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Multiple airway protective mechanisms are impacted with Parkinson's disease (PD), including swallowing and cough. Cough serves to eject material from the lower airways, and can be produced voluntarily (on command) and reflexively in response to aspirate material or other airway irritants. Voluntary cough effectiveness is reduced in PD however it is not known whether reflex cough is affected as well. The goal of this study was to compare the effectiveness between voluntary and reflex cough in patients with idiopathic PD. METHODS Twenty patients with idiopathic PD participated. Cough airflow data were recorded via facemask in line with a pneumotachograph. A side delivery port connected the nebulizer for delivery of capsaicin, which was used to induce cough. Three voluntary coughs and three reflex coughs were analyzed from each participant. A two-way repeated measures analysis of variance was used to compare voluntary versus reflex cough airflow parameters. RESULTS Significant differences were found for peak expiratory flow rate (PEFR) and cough expired volume (CEV) between voluntary and reflex cough. Specifically, both PEFR and CEV were reduced for reflex as compared to voluntary cough. CONCLUSION Cough PEFR and CEV are indicative of cough effectiveness in terms of the ability to remove material from the lower airways. Differences between these two cough types likely reflect differences in the coordination of the respiratory and laryngeal subsystems. Clinicians should be aware that evaluation of cough function using voluntary cough tasks overestimates the PEFR and CEV that would be achieved during reflex cough in patients with PD.
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Affiliation(s)
- Karen Wheeler Hegland
- Department of Speech Language and Hearing Sciences, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA; Center for Movement Disorders and Neurorestoration, College of Medicine, University of Florida, Gainesville, FL, USA.
| | - Michelle S Troche
- Department of Speech Language and Hearing Sciences, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA; Center for Movement Disorders and Neurorestoration, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Alexandra E Brandimore
- Department of Speech Language and Hearing Sciences, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA; Center for Movement Disorders and Neurorestoration, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Paul W Davenport
- Department of Physiological Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL, USA
| | - Michael S Okun
- Center for Movement Disorders and Neurorestoration, College of Medicine, University of Florida, Gainesville, FL, USA; Department of Neurology, College of Medicine, University of Florida, Gainesville, FL, USA
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Miles A, McFarlane M, Huckabee ML. Inter-rater reliability for judgment of cough following citric acid inhalation after training. SPEECH LANGUAGE AND HEARING 2014. [DOI: 10.1179/2050572814y.0000000040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Hegland KW, Okun MS, Troche MS. Sequential voluntary cough and aspiration or aspiration risk in Parkinson's disease. Lung 2014; 192:601-8. [PMID: 24792231 DOI: 10.1007/s00408-014-9584-7] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 04/07/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Disordered swallowing, or dysphagia, is almost always present to some degree in people with Parkinson's disease (PD), either causing aspiration or greatly increasing the risk for aspiration during swallowing. This likely contributes to aspiration pneumonia, a leading cause of death in this patient population. Effective airway protection is dependent upon multiple behaviors, including cough and swallowing. Single voluntary cough function is disordered in people with PD and dysphagia. However, the appropriate response to aspirate material is more than one cough, or sequential cough. The goal of this study was to examine voluntary sequential coughing in people with PD, with and without dysphagia. METHODS Forty adults diagnosed with idiopathic PD produced two trials of sequential voluntary cough. The cough airflows were obtained using pneumotachograph and facemask and subsequently digitized and recorded. All participants received a modified barium swallow study as part of their clinical care, and the worst penetration-aspiration score observed was used to determine whether the patient had dysphagia. RESULTS There were significant differences in the compression phase duration, peak expiratory flow rates, and amount of air expired of the sequential cough produced by participants with and without dysphagia. CONCLUSIONS The presence of dysphagia in people with PD is associated with disordered cough function. Sequential cough, which is important in removing aspirate material from large- and smaller-diameter airways, is also impaired in people with PD and dysphagia compared with those without dysphagia. There may be common neuroanatomical substrates for cough and swallowing impairment in PD leading to the co-occurrence of these dysfunctions.
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Affiliation(s)
- Karen Wheeler Hegland
- Department of Speech, Language and Hearing Sciences, University of Florida, 336 Dauer Hall, Gainesville, FL, 32611, USA,
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Stafford RE, Mazzone S, Ashton-Miller JA, Constantinou C, Hodges PW. Dynamics of male pelvic floor muscle contraction observed with transperineal ultrasound imaging differ between voluntary and evoked coughs. J Appl Physiol (1985) 2014; 116:953-60. [PMID: 24526580 DOI: 10.1152/japplphysiol.01225.2013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Coughing provokes stress urinary incontinence, and voluntary coughs are employed clinically to assess pelvic floor dysfunction. Understanding urethral dynamics during coughing in men is limited, and it is unclear whether voluntary coughs are an appropriate surrogate for spontaneous coughs. We aimed to investigate the dynamics of urethral motion in continent men during voluntary and evoked coughs. Thirteen men (28-42 years) with no history of urological disorders volunteered to participate. Transperineal ultrasound (US) images were recorded and synchronized with measures of intraabdominal pressure (IAP), airflow, and abdominal/chest wall electromyography during voluntary coughs and coughs evoked by inhalation of nebulized capsaicin. Temporal and spatial aspects of urethral movement induced by contraction of the striated urethral sphincter (SUS), levator ani (LA), and bulbocavernosus (BC) muscles and mechanical aspects of cough generation were investigated. Results showed coughing involved complex urethral dynamics. Urethral motion implied SUS and BC shortening and LA lengthening during preparatory and expulsion phases. Evoked coughs resulted in greater IAP, greater bladder base descent (LA lengthening), and greater midurethral displacement (SUS shortening). The preparatory inspiration cough phase was shorter during evoked coughs, as was the latency between onset of midurethral displacement and expulsion. Maximum midurethral displacement coincided with maximal bladder base descent during voluntary cough, but followed it during evoked cough. The data revealed complex interaction between muscles involved in continence in men. Spatial and temporal differences in urethral dynamics and cough mechanics between cough types suggest that voluntary coughing may not adequately assess capacity of the continence mechanism.
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Affiliation(s)
- Ryan E Stafford
- Centre for Clinical Research Excellence - Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
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Hegland KW, Troche MS, Davenport PW. Cough expired volume and airflow rates during sequential induced cough. Front Physiol 2013; 4:167. [PMID: 23847546 PMCID: PMC3701804 DOI: 10.3389/fphys.2013.00167] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Accepted: 06/15/2013] [Indexed: 12/02/2022] Open
Abstract
Cough effectiveness is determined by a combination of volume of air expired and maximum expiratory airflow rate. Studies of cough sensitivity identify cough thresholds based on at least 2 or 5-cough re-accelerations to a stimulus, however, to date no study has examined the interplay between the distribution of cough expired air and cough airflow rates for these induced sequential coughs. The goal of this study was to investigate the relationship between reflex cough re-accelerations, cough airflow and cough inspired and expired volume. Twenty adults (18–40 years, four men) volunteered for study participation, and were outfitted with a facemask in-line with a pneumotachograph and a one-way valve for capsaicin delivery on inspiration. Cough inspired and expired volume (Liters of air) as well as airflow parameters (peak expiratory flow rates L/s) were measured for each cough response. Results demonstrate significant linear relationships between cough expired volume, flow rates, and the total number of coughs produced. Thus, as the number of coughs in an epoch increase, the mechanical effectiveness of coughs within the epoch may decrease according to peak expiratory flow rates and cough expired volume, particularly for coughs comprised of more than 3 re-accelerations.
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Affiliation(s)
- Karen W Hegland
- Speech Language and Hearing Sciences, University of Florida Gainesville, FL, USA
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Miles A, Huckabee ML. Intra- and inter-rater reliability for judgement of cough following citric acid inhalation. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2013; 15:209-215. [PMID: 22873621 DOI: 10.3109/17549507.2012.692812] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
This study investigated the inter-rater and intra-rater reliability of subjective judgements of cough in patients following inhalation of citric acid. Eleven speech-language pathologists (SLPs) currently using cough reflex testing in their clinical practice (experienced raters) and 34 SLPs with no experience using cough reflex testing (inexperienced raters) were recruited to the study. Participants provided a rating of strong, weak, or absent to 10 video segments of cough responses elicited by inhalation of nebulized citric acid. The same video segments presented in a different sequence were re-evaluated by the same clinicians following a 15-minute break. Inter-rater reliability for experienced raters was calculated with a Fleiss' generalized kappa of .487; intra-rater reliability was higher with a kappa of .700. Inexperienced raters showed similar reliability, with kappa values for inter-rater and intra-rater reliability of .363 and .618, respectively. In conclusion, SLPs demonstrate only fair-to-moderate reliability in subjectively judging a patient's cough response to citric acid. Experience in making cough judgements does not improve inter-rater reliability significantly. Further validity and reliability research, including an evaluation of the effect of training on judgement reliability, would be beneficial for guiding clinical policies.
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Affiliation(s)
- Anna Miles
- University of Canterbury, Christchurch, New Zealand.
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Pollock RD, Rafferty GF, Moxham J, Kalra L. Respiratory muscle strength and training in stroke and neurology: a systematic review. Int J Stroke 2012; 8:124-30. [PMID: 22568454 DOI: 10.1111/j.1747-4949.2012.00811.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
We undertook two systematic reviews to determine the levels of respiratory muscle weakness and effects of respiratory muscle training in stroke patients. Two systematic reviews were conducted in June 2011 using a number of electronic databases. Review 1 compared respiratory muscle strength in stroke and healthy controls. Review 2 was expanded to include randomized controlled trials assessing the effects of respiratory muscle training on stroke and other neurological conditions. The primary outcomes of interest were maximum inspiratory and expiratory mouth pressure (maximum inspiratory pressure and maximum expiratory pressure, respectively). Meta-analysis of four studies revealed that the maximum inspiratory pressure and maximum expiratory pressure were significantly lower (P < 0·00001) in stroke patients compared with healthy individuals (weighted mean difference -41·39 and -54·62 cmH(2) O, respectively). Nine randomized controlled trials indicate a significantly (P = 0·0009) greater effect of respiratory muscle training on maximum inspiratory pressure in neurological patients compared with control subjects (weighted mean difference 6·94 cmH(2) O) while no effect on maximum expiratory pressure. Respiratory muscle strength appears to be impaired after stroke, possibly contributing to increased incidence of chest infection. Respiratory muscle training can improve inspiratory but not expiratory muscle strength in neurological conditions, although the paucity of studies in the area and considerable variability between them is a limiting factor. Respiratory muscle training may improve respiratory muscle function in neurological conditions, but its clinical benefit remains unknown.
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Affiliation(s)
- Ross D Pollock
- Department of Clinical Neurosciences, King's College London, London, UK.
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Abstract
Multiple studies suggest a role for the cerebral cortex in the generation of reflex cough in awake humans. Reflex cough is preceded by detection of an urge to cough; strokes specifically within the cerebral cortex can affect parameters of reflex cough, and reflex cough can be voluntarily suppressed. However, it is not known to what extent healthy, awake humans can volitionally modulate the cough reflex, aside from suppression. The aims of this study were to determine whether conscious humans can volitionally modify their reflexive cough and, if so, to determine what parameters of the cough waveform and corresponding muscle activity can be modified. Twenty adults (18-40 yr, 4 men) volunteered for study participation and gave verbal and written informed consent. Participants were seated and outfitted with a facemask and pneumotacograph, and two surface EMG electrodes were positioned over expiratory muscles. Capsaicin (200 μM) was delivered via dosimeter and one-way (inspiratory) valve attached to a side port between the facemask and pneumotachograph. Cough airflow and surface EMG activity were recorded across tasks including 1) baseline, 2) small cough (cough smaller or softer than normal), 3) long cough (cough longer or louder than normal), and 4) not cough (alternative behavior). All participants coughed in response to 200 μM capsaicin and were able to modify the cough. Variables exhibiting changes include those related to the peak airflow during the expiratory phase. Results demonstrate that it is possible to volitionally modify cough motor output characteristics.
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Affiliation(s)
- Karen W Hegland
- Department of Physiological Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA.
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Smith JA, Aliverti A, Quaranta M, McGuinness K, Kelsall A, Earis J, Calverley PM. Chest wall dynamics during voluntary and induced cough in healthy volunteers. J Physiol 2011; 590:563-74. [PMID: 22144580 DOI: 10.1113/jphysiol.2011.213157] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Coughing both protects the airways from foreign material and clears excessive secretions in respiratory diseases, and therefore requires high expiratory flows. We hypothesised that the volume inspired prior to coughing (operating volume) would significantly influence the mechanical changes during coughing and thus cough flow. Sixteen healthy volunteers (6 female, mean age 31 ± 10 years) performed six single voluntary coughs from four different operating volumes (10%, 30%, 60% and 90% of vital capacity) followed by three peals of voluntary and citric acid-induced coughs. During coughing we simultaneously measured (i) chest and upper abdominal wall motion using opto-electronic plethysmography (OEP), (ii) intra-thoracic and intra-abdominal pressures with a balloon catheter in each compartment and (iii) flow at the mouth. Operating volume was the most important determinant of the peak flow achieved and volume expelled during coughing, but had little influence on the pressures generated. The duration of single coughs increased with operating volume, whereas coughs were much shorter and varied little during peals. Voluntary cough peals were also associated with significant blood shift away from the trunk. In conclusion, this study has shown that operating volume is the most important determinant of cough peak flow and volume expelled in healthy individuals. During peals of coughs, similar mechanical effects were achieved more rapidly, suggesting a modification of the motor pattern with improved efficiency. Future studies investigating cough mechanics in health and disease should control for the influence of operating volume.
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Affiliation(s)
- Jaclyn A Smith
- Respiratory Research Group, University of Manchester, ERC Building, Second floor, Wythenshawe Hospital, Manchester M23 9LT, UK.
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Abstract
This review dissects the complex human cough reflex and suggests hypotheses about the evolutionary basis for the reflex. A mechanosensory-induced cough reflex conveys through branches of myelinated Aδ nerve fibers is not chemically reactive (i.e., capsaicin, bradykinin); possibly, its evolution is to prevent the harmful effects of aspiration of gastric or particulate contents into the lungs. This became necessary as the larynx moves closer to the opening of the esophagus as human ancestors adapt phonation over olfaction beginning less than 10 million years ago. The second type of cough reflex, a chemosensory type, is carried by unmyelinated C fibers. Supposedly, its origin dates back when prehistoric humans began living in close proximity to each other and were at risk for infectious respiratory diseases or irritant-induced lung injury. The mechanism for the latter type of cough is analogous to induced pain after tissue injury; and, it is controlled by the identical transient receptor potential vanilloid cation channel (TRPV1). The airways do not normally manifest nociceptive pain from a stimulus but the only consistent response that capsaicin and lung inflammation provoke in healthy human airways is cough. TRPA1, another excitatory ion channel, has been referred to as the "irritant receptor" and its activation also induces cough. For both types of cough, the motor responses are identical and via coordinated, precisely-timed and sequential respiratory events orchestrated by complex neuromuscular networking of the diaphragm, chest and abdominal respiratory muscles, the glottis and parts of the brain.
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Affiliation(s)
- Stuart M Brooks
- Colleges of Public Health and Medicine, University of South Florida, Tampa, Florida.
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Widdicombe J, Addington W, Fontana G, Stephens R. Voluntary and reflex cough and the expiration reflex; implications for aspiration after stroke. Pulm Pharmacol Ther 2011; 24:312-7. [DOI: 10.1016/j.pupt.2011.01.015] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2011] [Revised: 01/24/2011] [Accepted: 01/28/2011] [Indexed: 01/31/2023]
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Magni C, Chellini E, Lavorini F, Fontana GA, Widdicombe J. Voluntary and reflex cough: Similarities and differences. Pulm Pharmacol Ther 2011; 24:308-11. [DOI: 10.1016/j.pupt.2011.01.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2010] [Accepted: 01/17/2011] [Indexed: 01/30/2023]
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Lamraoui H, Bonvilain A, Robain G, Mozer P, Moreau-Gaudry A, Cinquin P, Gumery PY, Basrour S. Rectus abdominis electromyography and MechanoMyoGraphy comparison for the detection of cough. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2010; 2010:6502-5. [PMID: 21096953 DOI: 10.1109/iembs.2010.5627369] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
We recently developed a novel active implant for the treatment of severe stress urinary incontinence. This innovative medical device has been developed with the main purpose of reducing the mean urethral occlusive pressure of the current prosthesis. This goal is achieved by detecting circumstances implying either high or low intra-abdominal pressures by a single 3-axis accelerometer. In fact, posture and activity of the patient are monitored in real time. We investigated in this study the possibility of detecting cough events (one of the main causes of urine loss in incontinent patient) by MechanoMyoGraphy (MMG) of the Rectus Abdominis (RA) using the same accelerometer. We compared MMG signal detection characteristics (burst onset times and RMS values) to the method of reference, the ElectroMyoGraphy (EMG). It is shown that detection of cough effort by MMG presents lower performances, mostly in terms of cough anticipation, than EMG detection. However, MMG still remains a good option for an implantable system comparing to implantable EMG disadvantages.
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Affiliation(s)
- Hamid Lamraoui
- TIMA laboratory, CNRS, Grenoble INP, UJF, 38031, France.
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Steier J, Jolley CJ, Seymour J, Ward K, Luo YM, Polkey MI, Moxham J. Increased load on the respiratory muscles in obstructive sleep apnea. Respir Physiol Neurobiol 2010; 171:54-60. [PMID: 20117253 DOI: 10.1016/j.resp.2010.01.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2009] [Revised: 01/21/2010] [Accepted: 01/22/2010] [Indexed: 11/19/2022]
Abstract
We wished to quantify, in patients with obstructive sleep apnoea (OSA), the activity of the respiratory muscles in relation to upper airway occlusion and patency in sleep. We hypothesized that particular levels of neuromuscular activation are directly associated with upper airway patency. 21 patients with previously diagnosed OSA and 21 healthy control subjects underwent respiratory muscle testing and polysomnography. Neural respiratory drive, as measured by the electromyogram of the diaphragm (EMG(di)) was elevated in the obese OSA patients, awake and supine (13.1(5.6)%max), compared to normal subjects (mean (SD) 8.1(2.3)%max, p<0.01). During unobstructed breathing in sleep (stage N2) normal subjects had an EMG(di) of 7.7(3.9) compared to 22.8(19.2)%max in the OSA group (p<0.001). Prior to airway occlusion, EMG(submandibular) and EMG(di) dropped markedly, and then, following occlusion, increased progressively to their highest levels at airflow onset. Patients with OSA require specific and increased levels of neural respiratory drive to sustain ventilation in sleep.
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Affiliation(s)
- Joerg Steier
- King's College London School of Medicine, London, UK.
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Abstract
Cough is generated by a brainstem neural network. Chemical and mechanical stimulation of the airway can elicit a reflex cough and can elicit a cognitive sensation, the urge-to-cough. The sensation of an urge-to-cough is a respiratory-related sensation. The role of the respiratory sensation of an urge-to-cough is to engage behavioral modulation of cough motor action. Respiratory sensations are elicited by a combination of modalities: central neural, chemical, and mechanical. Stimulation of respiratory afferents or changes in respiratory pattern resulting in a cognitive awareness of breathing are mediated by central neural processes that are the cognitive neural basis for respiratory sensations, including the urge-to-cough. It is proposed that the urge-to-cough is a component of the cough motivation-to-action system. The urge-to-cough is induced by stimuli that motivate subjects to protect their airway by coughing. Cough receptor stimulation is gated into suprapontine brain systems. In the proposed cough motivation system, the cough stimulus would produce an urge-to-cough which then matches with the cognitive desire for a response to the urge. If a cough is produced by the motor action system, the descending cognitive drive modulates the brainstem cough neural network. Receptors within the respiratory system provide sensory feedback indicating if the cough occurred, the motor pattern, and the magnitude. The limbic system uses that information to determine if the coughing behavior satisfied the urge. Cough is stopped if the urge-to-cough is satisfied; if the urge has not been satisfied then the urge-to-cough will continue to motivate the central nervous system. The central component within this cough motivation system is the intrinsic brain mechanism which can be activated to start the cycle for motivating a cough, the urge-to-cough. Eliciting a cognitive urge-to-cough is dependent on the integration of respiratory afferent activity, respiratory motor drive, affective state, attention, experience, and learning.
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Affiliation(s)
- P W Davenport
- Department of Physiological Sciences, Box 100144, HSC, University of Florida, Gainesville, FL 32610, USA.
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