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Published ahead of print on April 5, 2007, doi:10.1164/rccm.200612-1841OC

Am. J. Respir. Crit. Care Med., Volume 175, Number 12, June 2007, 1266-1271

A more recent version of this article appeared on June 15, 2007
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Submitted on December 19, 2006
Accepted on April 5, 2007

Predictors of Ineffective Cough During a Chest Infection in Stable ALS Patients

Jesus Sancho1, Emilio Servera1*, Juan Diaz1, and Julio Marin1

1 Department of Respiratory Medicine, Respiratory Care Unit, Universitat de Valencia, Hospital Clinico Universitario, Valencia, Spain

* To whom correspondence should be addressed. E-mail: emilio.servera{at}uv.es.

Objective: To determine if a clinical or functional parameter in ALS patients in a stable condition could predict spontaneous cough ineffectiveness during a respiratory tract infection (RTI). Materials and method: Forty consecutive ALS patients, one-year prospective follow-up. Measurements: FEV1, FVC, FEV1/FVC, peak cough flow (PCF), peak velocity time (PVT) maximum inspiratory (PImax) and expiratory pressure (PEmax). Bulbar dysfunction evaluation: Norris scale bulbar sub-score (NBS). Results: Twenty-six patients (65%) had spontaneous cough ineffectiveness during an RTI. The best variables to predict non assisted cough during an RTI were NBS (p<0.01) with a cut-off point of 29 (sensitivity 0.89, specificity 0.90, positive predicted value 0.88, negative predictive value 0.87), and PCF (p<0.001) with a cut-off 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 cut-off point of 28.88 L/s2 (sensitivity 0.77, specificity 0.96, positive predictive value 0.91, negative predictive value 0.89). Conclusion: In stable ALS patients, bulbar dysfunction (NBS score < 29), PCF (< 4.25 L/s) and PCF/PVT (< 28.88 L/s2) could predict the risk of ineffective spontaneous cough during an RTI.
Key words: amyotrophic lateral sclerosis, neuromuscular disease, cough, peak cough flow, assisted cough, non-invasive ventilation.






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