The relationship between cough reflex testing (CRT) and silent aspiration in acute exacerbation of chronic obstructive pulmonary disease (COPD)

Waitemata District Health Board0 个研究点目标入组 50 人开始时间: 2013年11月20日最近更新: 2020年1月13日

适应症

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•50 consecutive patients admitted to North Shore Hospital with acute exacerbation of chronic obstructive pulmonary disease (COPD) as primary diagnosis or reason for admission will be approached for participation in the study. Hospital admission lists will be screened daily to identify eligible patients.

•Deemed palliative as per medical team (identifying aspiration for these patients would unlikely change their medical management and reversibility of cough reflex is considered unlikely);
•Neurological or neuromuscular impairments or progressive neurological disease e.g. stroke, bulbar and pseudobulbar palsy, Parkinson’s Disease, Multiple Sclerosis, Dementia, Motor Neurone Disease (to avoid referral bias due to known associations with dysphagia);
•Endotracheal intubation within previous three months (based on Mokhlesi et al., 2002);
•Previous or current tracheostomy;
•Cognitive impairment which would preclude obtaining informed consent;
•Current active smoking (smoking blunts cough reflex; Dicpinigaitis, 2003);
•Reported clinical symptoms or diagnosis of gastro-oesophageal reflux disease (GORD; can cause reduced Lx sensitivity; Phua et al., 2005);
•Known or suspected swallowing impairment unrelated to COPD;
•Previous head and/or neck surgery, injury or radiation;
•Current use of angiotensin-converting enzyme (ACE inhibitors; promotes cough & increases tussive effect; Morice et al., 1987);
•Current use of opiates (opiates have an antitussive effect; Morice et al., 2007).
•Known contraindications for FEES e.g. recent base of skull/facial fracture, recent history of severe/life-threatening epistaxis, sino-nasal and anterior skull base tumours/surgery, nasopharyngeal stenosis (guided by Royal College of Speech & Language Therapists, 2007).

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