Airway clearance in patients with Parkinson‘s disease – overview and possibilities of physiotherapeutic intervention

Czech version

Authors: M. Srp; O. Gál; R. Korteová; R. Jech; E. Růžička; M. Hoskovcová
Authors‘ workplace: Neurologická klinika a Centrum klinických neurověd, 1. LF UK a VFN v Praze
Published in: Cesk Slov Neurol N 2020; 83/116(4): 375-381
Category: Review Article
doi: https://doi.org/10.14735/amcsnn2020375

Overview

Up to 40% of patients with Parkinson‘s disease die due to pneumonia. In Parkinson‘s disease patients, the ability to maintain airway hygiene is often overlooked and not routinely assessed. Respiratory physiotherapy techniques can be used to make expectoration easier and more effective in these patients. The algorithm of choice of these techniques is governed by the results of cough efficiency and respiratory muscle strength examination.

Keywords:

Parkinson‘s disease – cough – peak cough fl ow – respiratory muscle strength – airway clearance techniques

Sources

1. Suttrup I, Warnecke T. Dysphagia in Parkinson’s disease. Dysphagia 2016; 31 (1): 24–32. doi: 10.1007/s00455-015-9671-9.

2. Huff A, Smith B, Brown A et al. Mechanisms for successful rehabilitation of cough in Parkinson‘s disease using expiratory muscle strength training. Perspectives of the ASHA Special Interest Groups 2017; 2 (13): 93–102. doi: 10.1044/persp2.SIG13.93.

3. Fall A, Saleh A, Fredrickson M. Survival time, mortality, and cause of death in elderly patients with Parkinson‘s disease: a 9-year follow-up. Mov Disord 2003; 18 (11): 1312–1316. doi: 10.1002/mds.10537.

4. Akbar U, Dham B, He Y et al. Incidence and mortality trends of aspiration pneumonia in Parkinson‘s disease in the United States 1979–2010. Parkinsonism Relat Disord 2015; 21 (9): 1082–1086. doi: 10.1016/j.parkreldis.2015.06.020.

5. Neumannová K, Kolek V (eds). Asthma bronchiale a chronická obstrukční plicní nemoc: možnosti komplexní léčby z pohledu fyzioterapeuta. Praha: Mladá fronta 2012.

6. Gal O, Srp M, Konvalinková R et al. Physiotherapy in Parkinson’s disease: building ParkinsonNet in Czechia. Parkinsons Dis 2017; 2017: 8921932. doi: 10.1155/2017/892 1932.

7. Evans JN, Jaeger MJ. Mechanical aspects of coughing. Pneumonologie 1975; 152 (4): 253–257. doi: 10.1007/BF02094938.

8. Leith DE. The development of cough. Am Rev Respir Dis 1985; 131 (5): S39–S42. doi: 10.1164/arrd.1985.131.S5.S39.

9. Francesco A, Aiello M, Bertorelli G et al. Cough, a vital reflex. mechanisms, determinants and measurements. Acta Biomed 2019; 89 (4): 477–480. doi: 10.23750/abm.v89i4.6182.

10. Shannon R, Baekey DM, Morris KF et al. Ventrolateral medullary respiratory network and a model of cough motor pattern generation. J Appl Physiol 1998; 84 (6): 2020–2035. doi: 10.1152/jappl.1998.84.6.2020.

11. Canning BJ, Chang AB, Bolser DC et al. Anatomy and neurophysiology of cough: CHEST Guideline and Expert Panel report. Chest 2014; 146 (6): 1633–1648. doi: 10.1378/chest.14-1481.

12. Ross BB, Gramiak R, Rahn H. Physical dynamics of the cough mechanism. J Appl Physiol 1955; 8 (3): 264–268. doi: 10.1152/jappl.1955.8.3.264.

13. Chatwin M. Mechanical aids for secretion clearance. Int J Respir Care 2009; 5 (2): 50–54.

14. Button B, Goodell HP, Atieh E et al. Roles of mucus adhesion and cohesion in cough clearance. Proc Natl Acad Sci U S A 2018; 115 (49): 12501–12506. doi: 10.1073/pnas.1811787115.

15. Allen NE, Canning CG, Sherrington C et al. Bradykinesia, muscle weakness and reduced muscle power in Parkinson‘s disease. Mov Disord 2009; 24 (9): 1344–1351. doi: 10.1002/mds.22609.

16. Skinner JW, Christou EA, Hass CJ. Lower extremity muscle strength and force variability in persons with Parkinson disease. J Neurol Phys Ther 2019; 43 (1): 56–62. doi: 10.1097/NPT.0000000000000244.

17. Hegland KW, Okun MS, Troche MS. Sequential voluntary cough and aspiration or aspiration risk in Parkinson’s disease. Lung 2014; 192 (4): 601–608. doi: 10.1007/s00408-014-9584-7.

18. Hegland KW, Troche MS, Brandimore AE et al. Comparison of voluntary and reflex cough effectiveness in Parkinson‘s disease. Parkinsonism Relat Disord 2014; 20 (11): 1226–1230. doi: 10.1016/j.parkreldis.2014.09.010.

19. Santos RB, Fraga AS, Coriolano M et al. Respiratory muscle strength and lung function in the stages of Parkinson’s disease. J Bras Pneumol 2019; 45 (6): e20180148. doi: 10.1590/1806-3713/e20180148.

20. Zhang W, Zhang L, Zhou N et al. Dysregulation of respiratory center drive (P0. 1) and muscle strength in patients with early stage idiopathic Parkinson’s disease. Front Neurol 2019; 10: 724. doi: 10.3389/fneur.2019.00 724.

21. Ebihara S, Saito H, Kanda A et al. Impaired efficacy of cough in patients with Parkinson disease. Chest 2003; 124 (3): 1009–1015. doi: 10.1378/chest.124.3.1009.

22. Fontana GA, Pantaleo T, Lavorini F et al. Defective motor control of coughing in Parkinson‘s disease. Am J Respir Crit Care Med 1998; 158 (2): 458–464. doi: 10.1164/ajrccm.158.2.9705094.

23. Silverman E, Carnaby G, Singletary F et al. Measurement of voluntary cough production and airway protection in parkinson disease. Arch Phys Med Rehabil 2016; 97 (3): 413–420. doi: 10.1016/j.apmr.2015.10.098.

24. Hainaut K, Duchateau J. Muscle fatigue, effects of training and disuse. Muscle Nerve 1989; 12 (8): 660–669. doi: 10.1002/mus.880120807.

25. Karpati G, Engel WK. Correlative histochemical study of skeletal muscle after suprasegmental denervation, peripheral nerve section, and skeletal fixation. Neurology 1968; 18 (7): 681–681. doi: 10.1212/wnl.18.7.681.

26. Fertl E, Doppelbauer A, Auff E. Physical activity and sports in patients suffering from Parkinson‘s disease in comparison with healthy seniors. J Neural Transm Park Dis Dement Sect 1993; 5 (2): 157–161. doi: 10.1007/BF02251206.

27. van Nimwegen M, Speelman AD, Hofman-van Rossum EJ et al. Physical inactivity in Parkinson’s disease. J Neurol 2011; 258 (12): 2214–2221. doi: 10.1007/s00415-011-6097-7.

28. Mu L, Sobotka S, Chen J et al. Altered pharyngeal muscles in Parkinson disease. J Neuropathol Exp Neurol 2012; 71 (6): 520–530. doi: 10.1097/NEN.0b013e318258381b.

29. Rossi B, Siciliano G, Carboncini MC et al. Muscle modifications in Parkinson‘s disease: myoelectric manifestations. Electroencephalogr Clin Neurophysiol 1996; 101 (3): 211–218. doi: 10.1016/0924-980x (96) 94672-x.

30. Pitts T, Bolser D, Rosenbek J et al. Impact of expiratory muscle strength training on voluntary cough and swallow function in Parkinson disease. Chest 2009; 135 (5): 1301–1308. doi: 10.1378/chest.08-1389.

31. Troche MS, Brandimore AE, Okun MS et al. Decreased cough sensitivity and aspiration in Parkinson disease. Chest 2014; 146 (5): 1294–1299. doi: 10.1378/chest.14-0066.

32. Leow L, Beckert L, Anderson T et al. Changes in chemosensitivity and mechanosensitivity in aging and Parkinson’s disease. Dysphagia 2012; 27 (1): 106–114. doi: 10.1007/s00455-011-9347-z.

33. Sawan T, Harris ML, Kobylecki C et al. Lung function testing on and off dopaminergic medication in Parkinson‘s disease patients with and without dysphagia. Mov Disord Clin Pract 2016; 3 (2): 146–150. doi: 10.1002/mdc3.12251.

34. Weiner P, Inzelberg R, Dividovich A et al. Respiratory muscle performance and the perception of dyspnea in Parkinson‘s disease. Can J Neurol Sci 2002; 29 (1): 68–72. doi: 10.1017/s031716710000175x.

35. Morice A, Fontana GA, Belvisi MG et al. ERS guidelines on the assessment of cough. Eur Respir J 2007; 29 (6): 1256–1276.

36. Silverman EP, Carnaby-Mann G, Pitts T et al. Concordance and discriminatory power of cough measurement devices for individuals with Parkinson disease. Chest 2014; 145 (5): 1089–1096.

37. Lee KK, Matos S, Ward K et al. Sound: a non-invasive measure of cough intensity. BMJ Open Respir Res 2017; 4 (1): e000178. doi: 10.1136/bmjresp-2017-000178.

38. Umayahara Y, Soh Z, Sekikawa K et al. A mobile cough strength evaluation device using cough sounds. Sensors 2018; 18 (11): 3810. doi: 10.3390/s18113810.

39. American Thoracic Society/European Respiratory Society. ATS/ERS Statement on respiratory muscle testing. Am J Respir Crit Care Med 2002; 166 (4): 518. doi: 10.1164/rccm.166.4.518.

40. Evans JA, Whitelaw WA. The assessment of maximal respiratory mouth pressures in adults. Respir Care 2009; 54 (10): 1348–1359.

41. Hough A. Hough‘s cardiorespiratory care. 5th ed. Amsterdam: Elsevier 2018.

42. Tomkiewicz R, Biviji A, King M. Effects of oscillating air flow on the rheological properties and clearability of mucous gel simulants. Biorheology 1994; 31 (5): 511–520. doi: 10.3233/bir-1994-31501.

43. Pieterse A, Hanekom SD. Criteria for enhancing mucus transport: a systematic scoping review. Multidiscip Respir Med 2018; 13 (1): 22. doi: 10.1186/s40248-018-0127-6.

44. Li S, Silva Y. Investigation of the frequency and force of chest vibration performed by physiotherapists. Physiother Can 2008; 60 (4): 341–348. doi: 10.3138/physio.60.4.341.

45. McCarren B, Alison JA, Herbert RD. Vibration and its effect on the respiratory system. Aust J Physiother 2006; 52 (1): 39–43. doi: 10.1016/s0004-9514 (06) 70060-5.

46. Kisner C, Colby LA, Borstad J. Therapeutic exercise: foundations and techniques. 7th ed. Philadelphia, USA: F.A. Davis Company 2017.

47. Saleem AF, Sapienza CM, Okun MS. Respiratory muscle strength training: treatment and response duration in a patient with early idiopathic Parkinson‘s disease. NeuroRehabilitation 2005; 20 (4): 323–333.

48. Kuo YC, Chan J, Wu YP et al. Effect of expiratory muscle strength training intervention on the maximum expiratory pressure and quality of life of patients with Parkinson disease. NeuroRehabilitation 2017; 41 (1): 219–226. doi: 10.3233/NRE-171474.

49. Reyes A, Castillo A, Castillo J. Effects of expiratory muscle training and air stacking on peak cough flow in individuals with Parkinson’s disease. Lung 2020; 198 (1): 207–211. doi: 10.1007/s00408-019-00291-8.

50. Reyes A, Castillo A, Castillo J et al. The effects of respiratory muscle training on peak cough flow in patients with Parkinson’s disease: a randomized controlled study. Clin Rehabil 2018; 32 (10): 1317–1327. doi: 10.1177/0269215518774832.

51. Sapienza C, Pitts T, Troche MS et al. Respiratory strength training: concept and intervention outcomes. Semin Speech Language 2011; 32 (1): 21–30. doi: 10.1055/s-0031-1271972.

52. Keus S, Munneke M, Graziano M et al. European physiotherapy guideline for Parkinson’s disease. Netherlands: KNGF/ParkinsonNet 2014.

53. Reyes A, Ziman M, Nosaka K. Respiratory muscle training for respiratory deficits in neurodegenerative disorders: a systematic review. Chest 2013; 143 (5): 1386–1394. doi: 10.1378/chest.12-1442.

54. Natera AO, Cardinale M, Keogh JW, The effect of high volume power training on repeated high-intensity performance and the assessment of repeat power ability: a systematic review. Sports Med 2020; 50 (7): 1317–1339. doi: 10.1007/s40279-020-01273-0.

55. Sivasothy P, Brown L, Smith IE et al. Effect of manually assisted cough and mechanical insufflation on cough flow of normal subjects, patients with chronic obstructive pulmonary disease (COPD), and patients with respiratory muscle weakness. Thorax 2001; 56 (6): 438–444. doi: 10.1136/thorax.56.6.438.

56. Chatwin M, Ross E, Hart N et al. Cough augmentation with mechanical insufflation/exsufflation in patients with neuromuscular weakness. Eur Respir J 2003; 21 (3): 502–508. doi: 10.1183/09031936.03.00048102.

57. Neumannová K, Doušová T, Sedlák V et al. The Czech Pneumological and Physiological Society and the Czech Society for Paediatric Pulmonology Guidelines for Long-term Home Treatment Using the CoughAssist Machine in Patients with Serious Cough Disorders. Cesk Slov Neurol N 2017; 80/113 (4): 480–484. doi: 10.14735/amcsnn2017480.

58. Sturkenboom I, Thijssen M, Gons-van Elsacker J et al. Guidelines for occupational therapy in Parkinson‘s disease rehabilitation. [oline]. Available from URL: https: //www.parkinsonnet.nl/app/uploads/sites/3/2019/11/ot_guidelines_final-npf__3_.pdf.

59. Smeltzer SC, Skurnick JH, Troiano R et al. Respiratory function in multiple sclerosis: utility of clinical assessment of respiratory muscle function. Chest 1992; 101 (2): 479–484. doi: 10.1378/chest.101.2.479.