Predictors of ineffective cough during a chest infection in patients with stable amyotrophic lateral sclerosis(2007)

  • 2007.01.01 Monday
  • 09:00

Sancho J, Servera E, Díaz J, Marín J. Predictors of ineffective cough during a chest infection in patients with stable amyotrophic lateral sclerosis. Am J Respir Crit Care Med. 2007 Jun 15;175(12):1266-71. doi: 10.1164/rccm.200612-1841OC. Epub 2007 Apr 5. PMID: 17413124.

 

Rationale: In patients with neuromuscular diseases, a chest infection is associated with a reduction in respiratory muscle function that may result in decreased cough effectiveness.

Objectives: To determine if a clinical or functional parameter in patients with amyotrophic lateral sclerosis (ALS) in a stable condition could predict spontaneous cough ineffectiveness during a respiratory tract infection.

Methods: Forty consecutive patients with ALS referred to our Respiratory Care Unit were studied during a one-year follow-up.

Measurements and main results: FEV(1), FVC, FEV(1)/FVC, peak cough flow (PCF), peak velocity time (PVT), maximum inspiratory and expiratory pressures, and bulbar dysfunction evaluation using the Norris scale bulbar subscore (NBS). A total of 26 patients (65%) had spontaneous cough ineffectiveness during a respiratory tract infection. The best variables to predict nonassisted cough during a respiratory tract infection were NBS (p < 0.01) with a cutoff point of 29 (sensitivity, 0.89; specificity, 0.90; positive predicted value, 0.88; negative predictive value, 0.87), PCF (p < 0.001) with a cutoff point of 4.25 L/s (sensitivity, 0.74; specificity, 0.85; positive predictive value, 0.71; negative predictive value, 0.85), and PCF/PVT (p < 0.001) with a cutoff point of 28.88 L/s(2) (sensitivity, 0.77; specificity, 0.96; positive predictive value, 0.91; negative predictive value, 0.89).

Conclusions: In patients with stable ALS, bulbar dysfunction (NBS < 29), PCF (< 4.25 L/s), and PCF/PVT (< 28.88 L/s(2)) could predict the risk of ineffective spontaneous cough during a respiratory tract infection.

 

理由:神経筋疾患患者では、胸部感染は呼吸筋機能の低下と関連しており、咳の効果が低下する可能性がある。

目的。目的:安定状態にある筋萎縮性側索硬化症(ALS)患者の臨床的または機能的パラメータが、呼吸器感染時の自然咳嗽の効果を予測できるかどうかを調べること。

方法。方法:当院の呼吸器ケア病棟に紹介されたALS患者40名を1年間追跡調査した。

測定値と主な結果。FEV(1)、FVC、FEV(1)/FVC、ピーク咳嗽流量(PCF)、ピーク速度時間(PVT)、最大吸気・呼気圧、Norris scale bulbar subscore(NBS)を用いた球機能障害評価。

合計 26 例(65%)の患者が呼吸器感染症中に効果的ではない自然咳嗽を認めた。呼吸器感染時の非補助的咳嗽を予測する最良の変数は、カットオフポイント29(感度、0.89、特異度、0.90、正の予測値、0.88、負の予測値、0.87)のNBS(p<0.01)、カットオフポイント4のPCF(p<0.001)であった。 25 L/s(感度、0.74、特異度、0.85、正の予測値、0.71、負の予測値、0.85)、カットオフポイント28.88 L/s(2)(感度、0.77、特異度、0.96、正の予測値、0.91、負の予測値、0.89)のPCF/PVT(p<0.001)。

結論。安定型ALS患者において、球機能障害(NBS<29)、PCF(<4.25 L/s)、PCF/PVT(<28.88 L/s(2))は、呼吸器感染時の効果のない自然咳嗽のリスクを予測することができた。

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