Comparison of voluntary cough function in community - dwelling elderly and its association with physical fitness

A nomogram to predict pulmonary complications after gastrointestinal surgery: a retrospective study

OBJECTIVE

We aimed at developing a nomogram able to predict postoperative pulmonary complications (PPC) after gastrointestinal surgery.

METHODS

We retrospectively analyzed the clinical data of patients who underwent gastrointestinal surgery at Jiangnan University Affiliated Hospital from December 2017 to May 2022. Patients were randomly divided into training cohort and validation cohort at a 7:3 ratio. The training cohort is divided into PPC group and Non-PPC group. The Least Absolute Shrinkage and Selection Operator (LASSO) method and logistic regression were used to determine the independent risk factors. The identified risk factors were used to construct a nomogram model for predicting the risk of PPC after gastrointestinal surgery. The nomogram model was validated by the area under the receiver operating characteristic curve (AUC) and decision curve analysis (DCA).

RESULTS

A total of 563 patients were admitted. The incidence of PPC was 17.6% (99/563). In the training cohort, multiple logistic regression showed that age, hypertension, history of respiratory diseases, preoperative albumin, intraoperative blood loss, postoperative intensive care unit (ICU) time, postoperative arterial oxygen partial pressure (PaO2), and postoperative tracheal intubation time were identified as the influencing factors of PPC (P < 0.05). We constructed a nomogram model for predicting the PPC of the training cohort, with a C-index of 0.857 (95%CI 0.812-0.902). In the validation cohort, the C-index of the model is 0.936 (95%CI 0.890-0.982). The ROC curve of the training cohort is 0.875 (95%CI 0.832-0.918), similar with validation cohort 0.929 (0.876-0.982). The calibration curve indicates that the predicted results are correlated with the observed results.

CONCLUSIONS

The constructed nomogram model has certain predictive value, and can provide a scientific reference for predicting the occurrence of PPC after gastrointestinal surgery.

Effects of Expiratory Muscle Strength Training on Oropharyngeal Swallow Physiology in Persons with Obstructive Sleep Apnea (OSA): A Preliminary Study

Despite the high estimated prevalence of dysphagia in OSA, there is a paucity of evidence supporting behavioral interventions for treatment. The purpose of this study was to assess the impact of expiratory muscle strength training (EMST) on validated, standardized metrics of swallow and airway clearance capacity functions in moderate-to-severe OSA. 10 participants with OSA (mean age = 65.2 years) completed four weeks of EMST training employing a prospective single-arm, double-baseline interventional design. The Modified Barium Swallow Impairment Profile (MBSImP) Component and Composite (Oral Total [OT] and Pharyngeal Total [PT]) scores measured swallow physiology. Airway clearance capacity measures included maximum expiratory pressure (MEP) and peak cough flow (PCF). A historical normative database was used for OSA patient comparison of swallowing metrics. A total of 234 swallows were analyzed. At baseline, impairments in lingual control, oral residue and esophageal clearance were observed. However, no significant differences in the MBSImP Composite (OT/PT) scores were observed between the OSA and healthy referent group. After EMST intervention, there were no significant differences in pre- to post-intervention Composite (OT/PT) scores. However, large effect size was observed for MEP (p < 0.001, d = 3.0), and non-significant, but moderate effect size was observed in PCF (p = 0.19, d = 0.44). Study findings further quantify swallowing in moderate-to-severe OSA and provide preliminary evidence supporting the impact of EMST on airway clearance capacity.

Aerobic exercise capacity, cough strength, posture, and depression in primary ciliary dyskinesia

INTRODUCTION

Assessment of exercise capacity is important for information about lung function and prognosis in primary ciliary dyskinesia (PCD). In addition, deterioration in the pulmonary system may affect cough efficiency, posture, and thoracoabdominal mobility. In turn, this deterioration may also disturb the psychological function of patients with PCD. Therefore, this study aimed to compare exercise capacity, cough strength, thoracoabdominal mobility, posture, and depression in children with PCD and healthy peers.

METHODS

Twenty-seven patients with PCD and 28 healthy peers were included. Aerobic exercise capacity (3-min step test), cough strength (peak expiratory flow meter), thoracoabdominal mobility (upper chest, lower chest, and abdomen), posture (Corbin postural assessment scale), and depression (Children's Depression Inventory) were evaluated.

RESULTS

Patients' number of steps completed, cough strength, and thoracoabdominal mobility were significantly decreased; total posture and depression scores were higher compared with healthy controls (p< 0.05). There was a significant relationship between cough strength and maximal expiratory strength (r = 0.541, p= 0.004) and total number of steps (r = 0.509, p= 0.007) in the patients.

CONCLUSION

Aerobic exercise capacity, cough strength, and thoracoabdominal mobility were impaired, posture was deteriorated, and depression perception elevated in children with PCD compared to healthy peers. Furthermore, aerobic exercise capacity and maximal expiratory strength are related to cough strength in these patients. Rehabilitation programs including aerobic and resistive exercise training, deep breathing and postural exercise, and nutrition counseling may improve these results and better be investigated. Trial registration: Clinicaltrials.gov: NCT03370029; December 12, 2017.

Voluntary Cough Effectiveness and Airway Clearance in Neurodegenerative Disease

PURPOSE

Voluntary cough dysfunction is highly prevalent across multiple patient populations. Voluntary cough has been utilized as a screening tool for swallowing safety deficits and as a target for compensatory and exercise-based dysphagia management. However, it remains unclear whether voluntary cough dysfunction is associated with the ability to effectively clear the airway.

METHOD

Individuals with neurodegenerative disorders performed same-day voluntary cough testing and flexible endoscopic evaluations of swallowing (FEES). Participants who were cued to cough after exhibiting penetration to the vocal folds and/or aspiration with thin liquids during FEES met inclusion criteria. One-hundred and twenty-three trials were blinded, and the amount of residue before and after a cued cough on FEES was measured with a visual analog scale. Linear and binomial mixed-effects models examined the relationship between cough airflow during voluntary cough testing and the proportion of residue expelled.

RESULTS

Peak expiratory flow rate (p = .004) and cough expired volume from the entire epoch (p = .029) were significantly associated with the proportion of aspiration expelled from the subglottis. Peak expiratory flow rate values of 3.00 L/s, 3.50 L/s, and 5.30 L/s provided high predicted probabilities that ≥ 25%, ≥ 50%, and ≥ 80% aspirate was expelled. Accounting for depth of aspiration significantly improved model fit (p < .001).

CONCLUSIONS

These findings suggest that voluntary cough airflow is associated with cough effectiveness to clear aspiration from the subglottis, although aspiration amount and depth may play an important role in this relationship. These findings provide further support for the clinical utility of voluntary cough in the management of dysphagia.

Relationship between kyphosis and cough strength and respiratory function of community-dwelling elderly

BACKGROUND

Kyphosis may reduce the force of coughing by affecting the factors related to cough peak flow (CPF). This study sought to compare cough strength and respiratory function between non-kyphotic and kyphotic elderly individuals and clarify the relationship between these factors.

METHODS

The non-kyphotic group comprised 17 elderly individuals with a kyphosis index of less than 15.1, while the kyphotic group comprised 21 elderly individuals with a kyphosis index of 15.1 or higher. Cough strength, respiratory function, respiratory muscle strength, and maximum phonation time were measured, and comparison between two groups and correlation analysis between variables were performed.

RESULTS

CPF, vital capacity, maximum expiratory pressure (PEmax), maximum inspiratory pressure (PImax), and chest expansion at the xiphoid process were significantly lower in the kyphotic group than in the non-kyphotic group. There were significant negative correlations between kyphosis index and CPF (r = -0.37, p < 0.05), PEmax (r = -0.45, p < 0.01), PImax (r = -0.44, p < 0.01) and chest expansion at the xiphoid process (r = -0.38, p < 0.05).

CONCLUSIONS

Our results demonstrated that cough strength was significantly lower in the kyphotic compared to non-kyphotic individuals. Furthermore, cough strength decreased with increased severity of kyphosis.