Relationship between pulmonary, cough, and swallowing functions in individuals with amyotrophic lateral sclerosis

Cara Donohue PhD, CCC-SLP, Terrie Vasilopoulos PhD, James P. Wymer MD, Emily K. Plowman PhD, CCC-SLP

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 cmH2O (±46.4), MIPcmH2O: 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.

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