Objective: To investigate the relationship between peak cough flow (PCF), oropharyngeal dysphagia and pneumonia in patients who were evaluated with videofluoroscopic swallowing study (VFSS).
Methods: Patients who performed both VFSS and PCF measurement on the same day from 23 July 2012 through 12 June 2019, were recruited (n=821). Presence of pneumonia within 1 month regarding the date of VFSS was assessed based on medical records, and the pneumonia (n=138) and control (n=683) groups were assigned. Sex, age (<65, ≥65 years), preceding conditions, Korean-version of Modified Barthel Index (K-MBI), Korean version of Mini-Mental State Examination (MMSE-K), PCF value (<160, 160-<270, and ≥270 L/min), and presence of aspiration/penetration on VFSS were reviewed. To make a comparison between the pneumonia and control groups, the Pearson chi-square test, the likelihood ratio and the Student t-test were used. Logistic regression analysis was used to investigate the associated factors of the pneumonia.
Results: The pneumonia group was more likely to be male (108, 78.3%), older than 65 years (121, 87.7%), with neurodegenerative diseases as preceding condition (25, 18.1%), and in poorer functional level with lower value of K-MBI (39.1 ± 26.59), however, the score of MMSE-K was not significantly different with control group. Pneumonia group also showed more aspiration/penetration rate (114, 82.6%) and lower value of PCF (136±73.65 L/min). In multivariable logistic regression analysis including sex, age, preceding conditions, presence of aspiration/penetration, and PCF, male sex (OR=6.62, 95% CI: 2.70-16.26), miscellaneous preceding conditions (OR=2.52, 95% CI: 1.14-5.58), presence of aspiration/penetration (OR=3.82, 95% CI: 1.42-10.23) and PCF <160 L/min (OR=14.34, 95% CI: 1.84-111.60) were significantly related factors with pneumonia.
Conclusions: Impaired swallowing and coughing function showed the independent association with the development of pneumonia. We recommend physicians to measure cough flow in patients at the risk of pneumonia regardless of the presence of dysphagia. Patients with PCF < 160 L/min require more attention with lung care and should be encouraged with voluntary coughing strategy to prevent possible pulmonary complications. |
