Hypotussic cough in persons with dysphagia: biobehavioral interventions and pathways to clinical implementation.
Justine Dallal-York, Michelle S Troche
PMID 38933659WHAT IT FOUND
Cough training and assisted clearance can improve cough measures in people with dysphagia who cough too little.
Skill-based cough practice and expiratory strength training helped in some groups, especially Parkinson's disease, but benefits varied by condition.
Key findings
01Hypotussia is downregulated cough with too little coughing, and in dysphagia it can leave aspirated material in the airway, increasing pneumonia and readmission risk.
02Cough interventions are organized into rehabilitative approaches, which aim for lasting change, and compensatory approaches, which give temporary airway clearance support.
03Expiratory muscle training and cough skill training improved cough measures in some studies, especially Parkinson's disease, but several studies found no significant change in cough airflow.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
This is a review and implementation resource, not a single controlled trial, so it does not directly test one intervention in one patient group. The evidence is mixed across diagnoses and outcomes. Some studies improved cough airflow, but others did not, including studies in ALS, healthy volunteers, multiple system atrophy, and total laryngectomy. Many studies were small, short, or did not directly test cough airflow, so improvements in muscle pressure may not mean safer coughing. The authors note limited visibility, time, resources, and formal training as barriers to using cough assessment and treatment in practice. The case vignettes are clinical examples, not outcome evidence, and should not be read as proof that a treatment worked. Some studies combined several treatments, such as EMST and cough skill training, so the contribution of each part is not clear.
Declared interests
Funded in part by an NIH NINDS R01 grant to Dr Michelle Troche. The authors declare that financial support was received for research, authorship, or publication.
The easy way to misread this
Do not read this review as proof that cough training will improve aspiration risk for every patient. The reviewed studies show variable cough airflow results, including no significant change in some populations, and the two clinical vignettes describe examples rather than tested outcomes.