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Dysphagia

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01-08-2021 | Amyotrophic Lateral Sclerosis | Original Article

Reflexive Airway Sensorimotor Responses in Individuals with Amyotrophic Lateral Sclerosis

Authors: Lauren Tabor-Gray, Terrie Vasilopoulos, Karen Wheeler-Hegland, James Wymer, Emily K. Plowman

Published in: Dysphagia | Issue 4/2021

Abstract

Background

Progressive motor denervation in amyotrophic lateral sclerosis (ALS) leads to reduced expiratory cough flow and diminished airway clearance physiologic capacity. Although ALS is thought to primarily impact motor systems, preliminary data from our laboratory suggest degradation of afferent pathways that regulate reflexive cough responses to radiographically confirmed aspiration. We, therefore, aimed to delineate both sensory and motor responses to a tussigenic airway irritant in individuals with ALS compared to healthy controls.

Methods

Thirty-two individuals with ALS and 34 healthy age and gender-matched controls completed reflex cough testing. Capsaicin stimuli (0, 50, 100, 150, 200 μM) were presented in a randomized three-block design and motor (cough spirometry metrics) and sensory (patient-rated urge to cough, UtC) ratings collected. ALS patients underwent videofluoroscopy with penetration-aspiration ratings completed. Descriptives, Mann–Whitney U, and mixed models ANOVAs were performed.

Results

Sensory: Individuals with ALS demonstrated greater UtC sensitivity slopes (i.e., increased stimulus sensitivity) vs. healthy controls (p = 0.036). Within the ALS group, however, silent aspirators (PAS = 8) demonstrated blunted UtC sensitivity slopes compared to ALS patients who did not (PAS ≤ 7, p = 0.0001). Motor: Compared to healthy controls, ALS individuals demonstrated reduced peak expiratory flow rates (p = 0.004), longer peak expiratory rise time (p = 0.017), and lower cough volume acceleration (p = 0.000).

Conclusions

ALS individuals demonstrated increased sensitivity to an upper airway irritant; however, they demonstrated slower and weaker expiratory cough motor output compared to healthy controls. In ALS silent aspirators, blunted sensorimotor responses were observed, suggesting that sensory degradation may occur at the final or most severe stage of bulbar disease progression.

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Title: Reflexive Airway Sensorimotor Responses in Individuals with Amyotrophic Lateral Sclerosis
Authors: Lauren Tabor-Gray
Terrie Vasilopoulos
Karen Wheeler-Hegland
James Wymer
Emily K. Plowman
Publication date: 01-08-2021
Publisher: Springer US
Keywords: Amyotrophic Lateral Sclerosis
Cough
Foreign Body Aspiration
Capsaicin
Foreign Body Aspiration
Aspiration
Cough
Cough
Dysphagia
Dysphagia
Dysphagia
Published in: Dysphagia / Issue 4/2021
Print ISSN: 0179-051X
Electronic ISSN: 1432-0460
DOI: https://doi.org/10.1007/s00455-020-10171-6

At a glance: The STEP trials

Springer Medicine

Reflexive Airway Sensorimotor Responses in Individuals with Amyotrophic Lateral Sclerosis

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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