Cough Effectiveness and Pulmonary Hygiene Practices in Patients with Pompe Disease
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While factors leading to hypoventilation have been well studied in Pompe disease, cough effectiveness and airway clearance practices are less understood. We aimed to identify significant factors that influence peak cough flow (PCF) in Pompe, and to detect whether pulmonary hygiene practices were reflective of reduced PCF.
This is a prospective observational study of 20 subjects with Pompe disease (infantile-onset: 7, juvenile-onset: 6, adult-onset: 14). Subjects performed spirometry, maximal respiratory pressures, and cough (voluntary: n = 24, spontaneous: n = 3). Subjects or their parents reported airway clearance and secretion management practices. Relationships between disease variables, pulmonary function, and cough parameters as well as group differences in cough parameters were evaluated.
Subjects with infantile-onset disease had significantly lower PCF (p < 0.05) and tended to require more external ventilatory support (p = 0.07). In juvenile- and adult-onset disease, PCF differed according to external ventilatory requirement [daytime: 83.6 L/min (95% CI 41.2–126.0); nighttime: 224.6 L/min (95% CI 139.1–310.2); none: 340.2 L/min (95% CI 193.3–487.6), p < 0.005]. Cough inspiratory volume also differed significantly by ventilatory requirement [daytime: 5.5 mL/kg (95% CI 3.0–8.0); nighttime: 16.0 mL/kg (95% CI 11.8–20.2); none: 26.8 mL/kg (95% CI 11.9–41.7), p < 0.001]. However, routine airway clearance or secretion management practices were only consistently reported among patients with infantile-onset disease (infantile: 86%, juvenile: 0%, adult: 14%, p < 0.005).
Cough weakness was detected in the majority of patients with Pompe disease and was influenced by both inspiratory and expiratory muscle function. Patients at risk for problems or with ineffective PCF should be urged to complete routine pulmonary hygiene.
KeywordsCough Pulmonary hygiene Pompe disease Respiratory muscles
Forced vital capacity
Maximal inspiratory pressure
Maximal expiratory pressure
Peak cough flow
Some data were collected as part of NCT02354651, supported by R21-HD090752 to BKS, through the National Institute of Child Health and Human Development.
Compliance with Ethical Standards
Conflict of interest
No conflicts exist for any of the authors.
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