A New Therapeutic Approach for Dystussia and Atussia in Neurogenic Dysphagia: Effect of Aerosolized Capsaicin on Peak Cough Flow.
Eliane Lüthi-Müller, Jan Kool, Veit Mylius and 1 others
PMID 35430718WHAT IT FOUND
Aerosolized capsaicin triggered effective cough in 24 of 28 patients with neurogenic dysphagia who had weak voluntary coughs.
This suggests the ability to cough exists but is inaccessible due to sensory deficits, offering a potential therapeutic target for airway clearance.
Key findings
01Reflexive peak cough flow was significantly higher than voluntary peak cough flow in the neurogenic dysphagia group.
02After exposure to aerosolized capsaicin, 85.8% of patients with neurogenic dysphagia produced an effective or partially effective cough, compared to 28.6% producing an effective cough on command.
03Patients with neurogenic dysphagia required significantly higher concentrations of capsaicin to induce cough compared to healthy controls.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
The groups were not matched for age and sex, with the ND group being older and the control group having more females. The study did not validate the specific peak cough flow thresholds for patients with neurogenic dysphagia, relying instead on values derived from neuromuscular disease populations. The home application method uses liquid cayenne extract, which has variable capsaicin concentrations, making precise dosing difficult compared to nebulizers. Eight patients with very strong reflexive coughs could not seal the mouthpiece, and their data were imputed using the highest measured value, which may bias results. The study did not assess long-term clinical outcomes such as actual reduction in aspiration pneumonia rates or quality of life.
Declared interests
The authors declare no conflicts of interest. The study received ethics approval from the Ethikkommission Kanton St. Gallen.
The easy way to misread this
Do not assume aerosolized capsaicin strengthens the cough muscle itself. The study indicates it helps patients access an existing but inaccessible cough potential via sensory stimulation. It may not benefit patients whose cough impairment is primarily due to motor weakness, such as those with amyotrophic lateral sclerosis.