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Evaluating cough: the role of dysphagia and aspiration: when should aspiration be suspected in a patient with cough?

Article Excerpt
* Cough can be a sign of aspiration in patients with dysphagia. Therefore, in evaluating patients with cough, the history should include a search for conditions associated with increased risk of impaired swallowing. These include conditions that require oropharyngeal suctioning, acute and degenerative neurological diseases (such as stroke, amyotrophic lateral sclerosis [ALS], and head trauma), cervical or brain surgery, head and neck cancer, and use of sedatives. (1)

In a number of studies, normal aging has been associated with impaired swallow function, thus placing the elderly at higher risk. Bed-bound nursing home patients who are reliant on others for feeding and oral care are at increased risk for aspiration aspiration pneumonia. (2-5)

In one study of nursing home residents, total assistance for oral care and reliance on gastric tube feeding were found to be independent predictors of pneumonia. (6) Among patients not requiring tube feedings, the likelihood of pneumonia was increased in those who were dependent for feeding, were current smokers, or were receiving more than 8 medications. (6)

An evaluation of swallowing is indicated for high-risk patients. Both videofluoroscopic evaluation performed in the radiology clinic and fiberoptic endoscopic evaluation of swallowing, which may be undertaken at the bedside, are considered the gold standard. The initial approach to identifying dysphagia is the clinical bedside evaluation of swallowing, performed by a speech-language pathologist. (7) This evaluation has a number of components, including the subjective assessment of reflexive (involuntary) cough and voluntary cough.

Reflexive and...

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