Relationship Between Pulmonary, Cough, and Swallowing Functions in Individuals with Amyotrophic Lateral Sclerosis

Overview

Journal Muscle Nerve

Date 2024 May 14

PMID 38742544

Authors

Cara Donohue

Terrie Vasilopoulos

James P Wymer

Emily K Plowman

Affiliations

Soon will be listed here.

Abstract

Introduction/aims: Evaluations of pulmonary, cough, and swallow function are frequently performed to assess disease progression in amyotrophic lateral sclerosis (ALS), yet the relationship between these functions remains unknown. We therefore aimed to determine relationships between these measures in individuals with ALS.

Methods: One hundred individuals with ALS underwent standardized tests: forced vital capacity (FVC), maximum expiratory/inspiratory pressure (MEP, MIP), voluntary cough peak expiratory flow (PEF), and videofluoroscopic swallow evaluation (VF). Duplicate raters completed independent, blinded ratings using the Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) scale. Descriptives, Spearman's Rho correlations, Kruskal-Wallis analyses, and Pearson's chi-squared tests were completed.

Results: Mean and standard deviation across pulmonary and cough measures were FVC: 74.2% predicted (± 22.6), MEP: 91.6 cmHO (± 46.4), MIP cmHO: 61.1 (± 28.9), voluntary PEF: 352.7 L/min (± 141.6). DIGEST grades included: 0 (normal swallowing): 31%, 1 (mild dysphagia): 48%, 2 (moderate dysphagia): 10%, 3 (severe dysphagia): 10%, and 4 (life-threatening dysphagia): 1%. Positive correlations were observed: MEP-MIP: r = .76, MIP-PEF: r = .68, MEP-PEF: r = .61, MIP-FVC: r = .60, PEF-FVC: r = .49, and MEP-FVC: r = .46, p < .0001. MEP (p = .009) and PEF (p = .04) differed across DIGEST safety grades. Post hoc analyses revealed significant between group differences in MEP and PEF across DIGEST safety grades 0 versus 1 and grades 0 versus 3, (p < .05).

Discussion: In this cohort of individuals with ALS, pulmonary function, and voluntary cough were associated. Expiratory metrics (MEP, PEF) were diminished in individuals with unsafe swallowing, increasing their risk for effectively defending the airway.

References

Harris P, Taylor R, Thielke R, Payne J, Gonzalez N, Conde J . Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2008; 42(2):377-81. PMC: 2700030. DOI: 10.1016/j.jbi.2008.08.010. View

Wang B, Carter F, Altman K . Relationship between Dysarthria and Oral-Oropharyngeal Dysphagia: The present evidence. Ear Nose Throat J. 2020; :145561320951647. DOI: 10.1177/0145561320951647. View

Enache I, Pistea C, Fleury M, Schaeffer M, Oswald-Mammosser M, Echaniz-Laguna A . Ability of pulmonary function decline to predict death in amyotrophic lateral sclerosis patients. Amyotroph Lateral Scler Frontotemporal Degener. 2017; 18(7-8):511-518. DOI: 10.1080/21678421.2017.1353097. View

Tabor L, Rosado K, Robison R, Hegland K, Humbert I, Plowman E . Respiratory training in an individual with amyotrophic lateral sclerosis. Ann Clin Transl Neurol. 2016; 3(10):819-823. PMC: 5048392. DOI: 10.1002/acn3.342. View

Ludolph A, Drory V, Hardiman O, Nakano I, Ravits J, Robberecht W . A revision of the El Escorial criteria - 2015. Amyotroph Lateral Scler Frontotemporal Degener. 2015; 16(5-6):291-2. DOI: 10.3109/21678421.2015.1049183. View

Tabor L, Gaziano J, Watts S, Robison R, Plowman E . Defining Swallowing-Related Quality of Life Profiles in Individuals with Amyotrophic Lateral Sclerosis. Dysphagia. 2016; 31(3):376-82. PMC: 4871719. DOI: 10.1007/s00455-015-9686-2. View

Robison R, DiBiase L, Ashley A, McElheny K, Anderson A, Wymer J . Swallowing Safety and Efficiency Impairment Profiles in Individuals with Amyotrophic Lateral Sclerosis. Dysphagia. 2021; 37(3):644-654. PMC: 8617061. DOI: 10.1007/s00455-021-10315-2. View

Chapin J, Gray L, Vasilopoulos T, Anderson A, DiBiase L, York J . Diagnostic utility of the amyotrophic lateral sclerosis Functional Rating Scale-Revised to detect pharyngeal dysphagia in individuals with amyotrophic lateral sclerosis. PLoS One. 2020; 15(8):e0236804. PMC: 7425890. DOI: 10.1371/journal.pone.0236804. View

Hutcheson K, Barbon C, Alvarez C, Warneke C . Refining measurement of swallowing safety in the Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) criteria: Validation of DIGEST version 2. Cancer. 2022; 128(7):1458-1466. PMC: 8917062. DOI: 10.1002/cncr.34079. View

10.

Matsuda C, Shimizu T, Nakayama Y, Haraguchi M . Cough peak flow decline rate predicts survival in patients with amyotrophic lateral sclerosis. Muscle Nerve. 2018; 59(2):168-173. DOI: 10.1002/mus.26320. View

11.

Andrews J, Meng L, Kulke S, Rudnicki S, Wolff A, Bozik M . Association Between Decline in Slow Vital Capacity and Respiratory Insufficiency, Use of Assisted Ventilation, Tracheostomy, or Death in Patients With Amyotrophic Lateral Sclerosis. JAMA Neurol. 2017; 75(1):58-64. PMC: 5833488. DOI: 10.1001/jamaneurol.2017.3339. View

12.

Plowman E, Watts S, Robison R, Tabor L, Dion C, Gaziano J . Voluntary Cough Airflow Differentiates Safe Versus Unsafe Swallowing in Amyotrophic Lateral Sclerosis. Dysphagia. 2016; 31(3):383-90. PMC: 4871758. DOI: 10.1007/s00455-015-9687-1. View

13.

Lechtzin N, Cudkowicz M, de Carvalho M, Genge A, Hardiman O, Mitsumoto H . Respiratory measures in amyotrophic lateral sclerosis. Amyotroph Lateral Scler Frontotemporal Degener. 2018; 19(5-6):321-330. DOI: 10.1080/21678421.2018.1452945. View

14.

Heiman-Patterson T, Khazaal O, Yu D, Sherman M, Kasarskis E, Jackson C . Pulmonary function decline in amyotrophic lateral sclerosis. Amyotroph Lateral Scler Frontotemporal Degener. 2021; 22(sup1):54-61. DOI: 10.1080/21678421.2021.1910713. View

15.

Khamankar N, Coan G, Weaver B, Mitchell C . Associative Increases in Amyotrophic Lateral Sclerosis Survival Duration With Non-invasive Ventilation Initiation and Usage Protocols. Front Neurol. 2018; 9:578. PMC: 6052254. DOI: 10.3389/fneur.2018.00578. View

16.

Plowman E, Watts S, Tabor L, Robison R, Gaziano J, Domer A . Impact of expiratory strength training in amyotrophic lateral sclerosis. Muscle Nerve. 2015; 54(1):48-53. PMC: 4879103. DOI: 10.1002/mus.24990. View

17.

Desport J, Preux P, Truong T, Vallat J, Sautereau D, Couratier P . Nutritional status is a prognostic factor for survival in ALS patients. Neurology. 1999; 53(5):1059-63. DOI: 10.1212/wnl.53.5.1059. View

18.

Plowman E, Tabor-Gray L, Rosado K, Vasilopoulos T, Robison R, Chapin J . Impact of expiratory strength training in amyotrophic lateral sclerosis: Results of a randomized, sham-controlled trial. Muscle Nerve. 2018; 59(1):40-46. DOI: 10.1002/mus.26292. View

19.

Chen A, Garrett C . Otolaryngologic presentations of amyotrophic lateralsclerosis. Otolaryngol Head Neck Surg. 2005; 132(3):500-4. DOI: 10.1016/j.otohns.2004.09.092. View

20.

. ATS/ERS Statement on respiratory muscle testing. Am J Respir Crit Care Med. 2002; 166(4):518-624. DOI: 10.1164/rccm.166.4.518. View