Annals of Rehabilitation Medicine

"Peak expiratory flow rate"

Original Articles

Dysphagia

Peak Voluntary Cough Flow and Oropharyngeal Dysphagia as Risk Factors for Pneumonia: Jayoon Choi, Sora Baek, Gowun Kim, Hee-won Park; Ann Rehabil Med 2021;45(6):431-439. Published online December 31, 2021; DOI: https://doi.org/10.5535/arm.21068

Abstract
PDF

Objective
To investigate the relationship between voluntary peak cough flow (PCF), oropharyngeal dysphagia, and pneumonia in patients who were evaluated with videofluoroscopic swallowing study (VFSS).
Methods
Patients who underwent both VFSS and PCF measurement on the same day were enrolled retrospectively (n=821). Pneumonia (n=138) and control (n=683) groups were assigned based on presence of pneumonia within 1 month from the date of VFSS assessment. In addition, sex, age (<65 and ≥65 years), preceding conditions, modified Barthel Index (MBI), Mini-Mental State Examination (MMSE), PCF value (<160, ≥160 and <270, and ≥270 L/min), and presence of aspiration/penetration on VFSS were reviewed.
Results
Pneumonia group was more likely to be male (n=108; 78.3%), ≥65 years (n=121; 87.7%), with neurodegenerative (n=25; 18.1%) or other miscellaneous diseases (n=50; 36.2%), and in poor functional level with lower value of MBI (39.1±26.59). However, MMSE was not significantly different in comparison to that of the control group. The pneumonia group was also more likely to have dysphagia (82.6%) and lower value of PCF (<160 L/min, 70.3%). In multivariable logistic regression analysis, male sex (odd ratio [OR]=6.62; 95% confidence interval [CI], 2.70–16.26), other miscellaneous diseases as preceding conditions (OR=2.52; 95% CI, 1.14–5.58), dysphagia (OR=3.82; 95% CI, 1.42–10.23), and PCF <160 L/min (OR=14.34; 95% CI, 1.84–111.60) were factors significantly related with pneumonia.
Conclusion
Impaired swallowing and coughing function showed an independent association with the development of pneumonia. 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.

Citations

Citations to this article as recorded by

Predictors of Pneumonia in Patients With Penetration-Aspirations Detected on Fiberoptic Endoscopic Evaluation of Swallowing
Raviv Allon, Elad Babayof, Yonatan Lahav, Yael Shapira-Galitz
Dysphagia.2025; 40(5): 1205. CrossRef
The Effect of a Complex Breathing Training Program on Pulmonary Function and Respiratory Muscle Strength in Patients with Parkinson's Disease
Dong-Yeon Kang
Journal of The Korean Society of Physical Medicine.2025; 20(2): 127. CrossRef
Prognostic value of cough force measured by peak expiratory flow in a 4-year longitudinal cohort study of geriatric patients with oropharyngeal dysphagia
Kiril Stoev, Rainer Wirth, Bendix Labeit, Paul Muhle, Sonja Suntrup-Krueger, Rainer Dziewas, Gero Lueg, Ulrike Sonja Trampisch, Maryam Pourhassan
Frontiers in Aging.2025;[Epub] CrossRef
Classifying neurogenic dysphagia as a movement disorder
Corinne A Jones, Maggie-Lee Huckabee, Georgia A Malandraki, David Paydarfar
Brain.2025; 148(10): 3456. CrossRef
Peak cough flow and diaphragmatic excursion during coughing in stroke patients with tracheostomy: a cross-sectional study
Dan Li, Pengfei Yao, Juan Wang, Yulong Wang
Topics in Stroke Rehabilitation.2025; : 1. CrossRef
Does Cough Peak Flow Hold the Key to Safer Swallowing Assessments in Acute Brain Injury?
Fabiana Nery Ribeiro Oliveira, Fernando de Aguiar Lemos, Thaís Ferreira Lopes Diniz Maia, Maria Deborah Monteiro de Albuquerque, Armèle Dornelas de Andrade, Paulo André Freire Magalhães, Yujie Chen
International Journal of Clinical Practice.2025;[Epub] CrossRef
Sound‐based cough peak flow estimation in patients with neuromuscular disorders
Bernat Bertran Recasens, Ana Balañá Corberó, Juana María Martínez Llorens, Anna Guillen‐Sola, Montserrat Villatoro Moreno, Greta García Escobar, Yasutaka Umayahara, Zu Soh, Toshio Tsuji, Miguel Ángel Rubio
Muscle & Nerve.2024; 69(2): 213. CrossRef
Differences in cough strength, respiratory function, and physical performance in older adults with and without low swallowing function in the repetitive saliva swallowing test
Hideo Kaneko, Akari Suzuki, Yoshiharu Nagai, Jun Horie
Journal of Physical Therapy Science.2024; 36(5): 273. CrossRef
Effect of Inspiratory Muscle Training on Cough Strength in Older People With Frailty: A Single-Blind Randomized Controlled Trial
Tatsuya Morishita, Shusuke Toyama, Kazuaki Suyama, Fumiya Nagata, Masatoshi Itaki, Takako Tanaka, Shuntaro Sato, Yuji Ishimatsu, Terumitsu Sawai, Ryo Kozu
Archives of Physical Medicine and Rehabilitation.2024; 105(11): 2062. CrossRef
Effects of Home-Based Daily Respiratory Muscle Training on Swallowing Outcomes in Patients with Chronic Stroke: Protocol for a Randomized Controlled Trial
Mónica Zapata-Soria, Irene Cabrera-Martos, Alejandro Heredia-Ciuró, Esther Prados-Román, Javier Martín-Nuñez, Marie Carmen Valenza
Journal of Clinical Medicine.2024; 13(18): 5547. CrossRef
Flujo máximo de tos y evaluación de la deglución: Una revisión de literatura
Amalia Nanjarí R , María del Carmen Campos
Revista Científica Signos Fónicos.2024; 10(1): 7. CrossRef
Metabolic and ventilatory changes during postural change from the supine position to the reclining position in bedridden older patients
Yoji Yamada, Yuji Mitani, Akio Yamamoto, Kazumo Miura, Kanji Yamada, Yukari Oki, Yutaro Oki, Yasumichi Maejima, Yoko Kurumatani, Akira Ishikawa
Medicine.2023; 102(10): e33250. CrossRef
Correlation Between Articulatory Diadochokinetic Parameters and Dysphagia Parameters in Subacute Stroke Patients
Back Min Oh, Hyun Seok, Sang-Hyun Kim, Seung Yeol Lee, Su Jung Park, Beom Jin Kim, Hyun Jung Kim
Annals of Rehabilitation Medicine.2023; 47(3): 192. CrossRef
Deterioration of Cough, Respiratory, and Vocal Cord Functions in Patients with Multiple System Atrophy
Takashi Asakawa, Mieko Ogino, Naomi Tominaga, Naoto Ozaki, Jin Kubo, Wataru Kakuda
Neurology International.2023; 15(4): 1227. CrossRef

7,816 View
226 Download
12 Web of Science
14 Crossref

Clinical Importance of Peak Cough Flow in Dysphagia Evaluation of Patients Diagnosed With Ischemic Stroke: Sang Won Min, Se Hyun Oh, Ghi Chan Kim, Young Joo Sim, Dong Kyu Kim, Ho Joong Jeong; Ann Rehabil Med 2018;42(6):798-803. Published online December 28, 2018; DOI: https://doi.org/10.5535/arm.2018.42.6.798

Abstract
PDF

Objective
To investigate the relationship between peak cough flow (PCF), pulmonary function tests (PFT), and severity of dysphagia in patients with ischemic stroke.
Methods
This study included patients diagnosed with ischemic stroke, who underwent videofluoroscopic swallowing study (VFSS), PCF and PFT from March 2016 to February 2017. The dysphagia severity was assessed using the videofluoroscopic dysphagia scale (VDS). Correlation analysis of VDS, PFT and PCF was performed. Patients were divided into three groups based on VDS score. One-way ANOVA of VDS was performed to analyze PCF, forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and age among the different groups.
Results
The correlation coefficients of VDS and PCF, VDS and FVC, and VDS and FEV1 were -0.836, -0.508, and -0.430, respectively, all of which were statistically significant at the level of p<0.001. The one-way ANOVA indicated statistically significant differences in PCF, FVC, FEV1, and age among the VDS groups. Statistically significant differences in VDS and age were observed between aspiration pneumoia and non-aspiration pneumonia groups.
Conclusion
Coughing is a useful factor in evaluating the risk of aspiration in dysphagia patients. Evaluation of respiratory and coughing function should be conducted during the swallowing assessment of patients with ischemic stroke.

Citations

Citations to this article as recorded by

Impact of inspiratory muscle training on aspiration symptoms in patients with dysphagia following ischemic stroke
Shan Liu, Zhenfeng Fan, Minke FU, Keling Cheng, Xin Zhang, Jun Ni, ZhiYong Wang
Brain Research.2025; 1850: 149396. CrossRef
Predicting pneumonia algorithm in stroke patients
Jong Weon Lee, Hyun-Joung Lee, Hyeon Ju Jang, Yeseul Yun, Deog Young Kim
Frontiers in Neurology.2025;[Epub] CrossRef
Does Cough Peak Flow Hold the Key to Safer Swallowing Assessments in Acute Brain Injury?
Fabiana Nery Ribeiro Oliveira, Fernando de Aguiar Lemos, Thaís Ferreira Lopes Diniz Maia, Maria Deborah Monteiro de Albuquerque, Armèle Dornelas de Andrade, Paulo André Freire Magalhães, Yujie Chen
International Journal of Clinical Practice.2025;[Epub] CrossRef
Pulmonary Function Tests Post-Stroke. Correlation between Lung Function, Severity of Stroke, and Improvement after Respiratory Muscle Training
Fotios Drakopanagiotakis, Konstantinos Bonelis, Paschalis Steiropoulos, Dimitrios Tsiptsios, Anastasia Sousanidou, Foteini Christidi, Aimilios Gkantzios, Aspasia Serdari, Styliani Voutidou, Chrysoula-Maria Takou, Christos Kokkotis, Nikolaos Aggelousis, Ko
Neurology International.2024; 16(1): 139. CrossRef
A simple nomogram for predicting aspiration associated with dysphagia in hospitalized patients after stroke
Lihua Chen, Juan Li, Fang Tian, Huan Tang, Zuoxiu Chen, Chao Xue, Mingqing Hao, Juan Xue
Neurological Sciences.2024; 45(6): 2729. CrossRef
Flujo máximo de tos y evaluación de la deglución: Una revisión de literatura
Amalia Nanjarí R , María del Carmen Campos
Revista Científica Signos Fónicos.2024; 10(1): 7. CrossRef
Predictive Ability of Systemic Inflammation Response Index for the Risk of Pneumonia in Patients with Acute Ischemic Stroke
Dan Yan, Caijun Dai, Ruoting Xu, Qiqi Huang, Wenwei Ren
Gerontology.2023; 69(2): 181. CrossRef
Effect of transcranial direct current stimulation combined with respiratory training on dysphagia in post-stroke patients
Hao Li, Long Zhao, Xiaokai Yuan, Qingjuan Zhang, Yatao Pang, Hongling Li
Technology and Health Care.2023; 31(1): 11. CrossRef
Oropharyngeal Dysphagia in Acute Cervical Spinal Cord Injury: A Literature Review
Jackie McRae, Sarah Morgan, Emma Wallace, Anna Miles
Dysphagia.2023; 38(4): 1025. CrossRef
Could clinical nursing procedures lead to tracheal cuff pressure drop? A prospective observational study
Lijun Xiang, Meng Cao, Yuan Wang, Xuemei Song, Miaoqin Tan, Xiaomei Zhang
Journal of Clinical Nursing.2022; 31(5-6): 623. CrossRef
Cough reflex testing in clinical dysphagia practice
Emma S. Wallace, Maggie-lee Huckabee, Phoebe Macrae
Advances in Communication and Swallowing.2022; 25(2): 73. CrossRef
Vitamin D level in relation to phonetic function among subacute stroke patients
Eo Jin Park, Seung Don Yoo
Medicine.2022; 101(50): e31769. CrossRef
Questionnaire survey on nurses and speech therapists regarding dysphagia rehabilitation in Japan
Kengo Kato, Ryoukichi Ikeda, Jun Suzuki, Ai Hirano-Kawamoto, Yayoi Kamakura, Masako Fujiu-Kurachi, Masamitsu Hyodo, Shin-Ichi Izumi, Shigeto Koyama, Keiichi Sasaki, Junko Nakajima, Takahiro Karaho, Yurika Kimura, Yoshihiko Kumai, Yasushi Fujimoto, Takahar
Auris Nasus Larynx.2021; 48(2): 241. CrossRef
Relationship between Swallowing Function, Diet Level and Pulmonary Function in Post-Stroke Patients
Myungeun Yoo, Hyo Jeong Lee, Eu Jeong Ko, Jinyoung Park, Yoon Ghil Park
Journal of the Korean Dysphagia Society.2021; 11(1): 25. CrossRef
Usefulness of Maximal Expiratory Pressure in Evaluating Dysphagia after Ischemic Stroke
Bo Seong Jang, Ho Joong Jeong, Han Eum Choi, Jae Hyun Lee, Young Joo Sim, Ghi Chan Kim
Journal of the Korean Dysphagia Society.2021; 11(1): 59. CrossRef
Utilizing Pulmonary Function Parameters to Predict Dysphagia in Individuals With Cervical Spinal Cord Injuries
So Jung Lee, Sungchul Huh, Sung-Hwa Ko, Ji Hong Min, Hyun-Yoon Ko
Annals of Rehabilitation Medicine.2021; 45(6): 450. CrossRef
Peak Voluntary Cough Flow and Oropharyngeal Dysphagia as Risk Factors for Pneumonia
Jayoon Choi, Sora Baek, Gowun Kim, Hee-won Park
Annals of Rehabilitation Medicine.2021; 45(6): 431. CrossRef
Response to the Commentary on ‘Concordant Validity of a Digital Peak Cough Flow Meter to Assess Voluntary Cough Strength in Individuals with ALS’
L. Tabor Gray, T. Vasilopoulos, E. K. Plowman
Dysphagia.2020; 35(5): 876. CrossRef

9,070 View
290 Download
14 Web of Science
18 Crossref

Effect of Functional Electrical Stimulation on Clearance of Broncheal Secretion in Patients with High Spinal Cord Injury.: Shin, Ji Cheol , Kang, Seong Woong , Park, Chang Il , Kang, Youn Joo , Kim, Sung Weon , Ahn, Jae Ki; J Korean Acad Rehabil Med 1998;22(3):559-565.

Abstract
PDF

Objective: To determine the effects of abdominal functional electrical stimulation(FES) on the ability to clear the broncheal secretion in high spinal cord injury(SCI) patients.

Method: Eleven cervical SCI male patients were assessed for the pulmonary function using a routine pulmonary function test. Maximal expiratory pressure(MEP) and peak expiratory flow rate(PEFR) measurements were recorded during (1) spontaneous cough attempts and (2) cough attempts with FES applied to the abdominal wall. Each measurement was recorded in supine and sitting positions. The portable FES unit was set at 24 Hz, with a pulse width of 150 microsecond(ㄍs), an asymmetrical biphasic waveform and a maximal intensity to 90 mA.

Results: All subjects had a decreased vital capacity, peak expiratory flow and increased ratio of forced expiratory volume at one second(FEV1) to the forced vital capacity(FVC) in a routine pulmonary function test. These cervical SCI patients were greatly reduced the MEP and the PEFR when they coughed spontaneously. FES-assisted coughing increased the MEP and PEFR in all patients in a supine and sitting positions with statistical significance(p＜0.05).

Conclusion: By increasing the MEP and PEFR, abdominal FES could enhance the coughs in high SCI patients. Abdominal FES can be a useful physical therapy for the prevention and treatment of pulmonary complications in high SCI patients at the bed side as well as at homes.