Coughing and choking in motor neuron disease
- aDepartment of Medicine (Neurology), University of Wales College of Medicine, Cardiff, UK, bThe Common Cold Centre, Cardiff School of Biosciences, Cardiff University, UK
- Dr S Hadjikoutis, Department of Neurology, University Hospital of Wales, Heath Park, Cardiff, CF4 4XN, UKHadjikoutissa{at}cf.ac.uk
- Received 28 September 1999
- Revised 21 December 1999
- Accepted 5 January 2000
Abstract
OBJECTIVES To assess the frequency and severity of coughing and choking episodes, possible related factors, and their association with chest infections in patients with motor neuron disease (MND).
METHODS Thirty seven patients with MND and 23 healthy volunteers were studied. Cough was assessed using a questionnaire and a 3 day diary, and volitional cough quantified by peak cough flow and sound intensity. Other clinical symptoms, smoking habit, affective state, oral secretions, bulbar signs, and quantitative assessments of swallowing and respiratory function were documented.
RESULTS Patients with MND coughed and choked significantly more often and to a greater degree than the healthy volunteers (26 of 37 patients with MND and 2 of 23 volunteers, p<0.001). Female sex, older age, abnormal speech, reduced swallowing capacity, and low forced vital capacity (FVC)% predicted were each significantly associated with excessive coughing and choking episodes in patients with MND. Smokers had significantly more severe and prolonged episodes of coughing and choking than non-smokers (p<0.05). Patients with upper motor neuron bulbar signs had a greater tendency to severe and prolonged episodes of coughing and choking than those without (p<0.05). Chest infections were reported only rarely among the patients who coughed and choked.
CONCLUSIONS Coughing and choking episodes are common in patients with MND but infrequently associated with overt chest infection. Upper motor neuron bulbar signs may both promote factors (for instance, dysphagia) which trigger cough and reduce volitional capacity to suppress it.
