Why does a stroke patient cough?

  1. Vernino S, Brown RD Jr, Sejvar JJ, Sicks JD, Petty GW, O'Fallon WM. Cause-specific mortality after first cerebral infarction: a population-based study. Stroke. 2003;34(8):1828–32.

    Article  Google Scholar 

  2. Watts SA, Tabor L, Plowman EK. To cough or not to cough? Examining the potential utility of cough testing in the clinical evaluation of swallowing. Curr Phys Med Rehabil Rep. 2016;4(4):262–76.

    Article  Google Scholar 

  3. Ward K, Seymour J, Steier J, Jolley CJ, Polkey MI, Kalra L, et al. Acute ischaemic hemispheric stroke is associated with impairment of reflex in addition to voluntary cough. Eur Respir J. 2010;36(6):138–390.

    Article  Google Scholar 

  4. Martino R, Beaton D, Diamant NE. Using different perspectives to generate items for a new scale measuring medical outcomes of dysphagia (MOD). J Clin Epidemiol. 2009;62(5):518–26.

    Article  Google Scholar 

  5. Hussein HM, Abdel Moneim A, Emara T, Abd-Elhamid YA, Salem HH, AbdAllah F, et al. Arabic cross cultural adaptation and validation of the National Institutes of Health Stroke Scale. J Neurol Sci. 2015;357:152–6.

    Article  Google Scholar 

  6. Mann GD. MASA: The Mann Assessment of Swallowing Ability. In Dysphagia Series (the author, ed.). Singular Thomson Learning, New York, NY. 2002. p. 56.

  7. Hoffmann S, Malzahn U, Harms H, Koennecke HC, Berger K, Kalic M, et al. Berlin Stroke Register and the Stroke Register of Northwest Germany. Development of a clinical score (A2DS2) to predict pneumonia in acute ischemic stroke. Stroke. 2012;43(10):2617–23.

    Article  Google Scholar 

  8. Tanaka M, Maruyama K. Mechanisms of capsaicin- and citric-acidinduced cough reflexes in guinea pigs. J Pharmacol Sci. 2005;99(1):77–82.

    Article  CAS  Google Scholar 

  9. Leow LP, Beckert L, Anderson T, Huckabee ML. Changes in chemosensitivity and mechanosensitivity in aging and Parkinson's disease. Dysphagia. 2012;27(1):106–1.

    Article  Google Scholar 

  10. Morice AH, Kastelik JA, Thompson R. Cough challenge in the assessment of cough reflex. Br J Clin Pharmacol. 2001;52(4):365–75.

    Article  CAS  Google Scholar 

  11. Thrift AG, Thayabaranathan T, Howard G, Howard VJ, Rothwell PM, Feigin VL, et al. Global stroke statistics. Int J Stroke. 2017;12(1):13–32.

    Article  Google Scholar 

  12. Sellars G, Bowie L, Bagg J, Sweeney MP, Miller H, Tilston J, et al. Risk factors for chest infection in acute stroke: a prospective cohort study. Stroke. 2007;38(8):2284–91.

    Article  Google Scholar 

  13. Westendorp WF, Vermeij JD, Brouwer MC, Roos YB, Nederkoorn PJ, van de Beek D. Pre-stroke use of beta-blockers does not lower post-stroke infection rate: an exploratory analysis of the preventive antibiotics in stroke study. Cerebrovasc Dis. 2016;42:506–5.

    Article  CAS  Google Scholar 

  14. Eizenberg Y, Grossman E, Tanne D, Koton S. Pre admission treatment with Beta-blockers in hypertensive patients with acute stroke and 3-month outcomeData from a national stroke registry. J Clin Hypertens (Greenwich). 2018;20(3):568–72.

    Article  CAS  Google Scholar 

  15. Vilardell N, Rofes L, Arreola V, Speyer R, Clavé P. A comparative study between modified starch and xanthan gum thickeners in post-stroke oropharyngeal dysphagia. Dysphagia. 2016;31(2):169–79.

    Article  CAS  Google Scholar 

  16. Field M, Wenke R, Sabet A, Lawrie M, Cardell E. Implementing cough reflex testing in a clinical pathway for acute stroke: a pragmatic randomised controlled trial. Dysphagia. 2018;33(6):827–39.

    Article  Google Scholar 

  17. Miles A, Moore S, McFarlane M, Lee F, Allen J, Huckabee ML. Comparison of cough reflex test against instrumental assessment of aspiration. Physiol Behav. 2013;118:25–31.

    Article  CAS  Google Scholar 

  18. Vilardell N, Rofes L, Nascimento WV, Muriana D, Palomeras E, Clavé P. Cough reflex attenuation and swallowing dysfunction in sub-acute post stroke patients: prevalence, risk factors, and clinical outcome. Neurogastroenterol Motil. 2017;29(1):6–9.

    Article  Google Scholar 

  19. Zapata-Arriaza E, Moniche F, Blanca PG, Bustamante A, Escudero-Martínez I, Uclés O, et al. External validation of the ISAN, A2DS2, and AISAPS scores for predicting stroke-associated pneumonia. J Stroke Cerebrovasc Dis. 2018;27(3):673–6.

    Article  Google Scholar 

  20. Nakajoh K, Nakagawa T, Sekizawa K, Matsui T, Arai H, Sasaki H. Relation between incidence of pneumonia and protective reflexes in post-stroke patients with oral or tube feeding. J Intern Med. 2000;247:39–42.

    Article  CAS  Google Scholar 

  21. Bianchi C, Baiardi P, Khirani S, Cantarella CG. Cough peak flow as a predictor of pulmonary morbidity in patients with dysphagia. Am J Phys Med Rehabil. 2012;91:1.

    Article  Google Scholar 

  22. Sohn D, Park GY, Koo H, Jang Y, Han Y, Im S. Determining peak cough flow cutoff values to predict aspiration pneumonia among patients with dysphagia using the citric acid reflexive cough test. Arch Phys Med Rehabil. 2018;99(12):2532–9.

    Article  Google Scholar 


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Demographic and clinical data characteristics
Age in years (mean ± SD)59.59 ± 13.12
A2DS2 (mean ± SD)4.26 ± 1.62
NIHSS(mean ± SD)10.83 ± 5.53
MANN total (mean ± SD)154.59 ± 43.66
Sex (no (%))Male60 (59.4%)
Female41 (40.6%)
Habits (no (%))No64 (63.4%)
Smoking35(34.7%)
Other drug abuse2 (2.0%)
Occupation (no (%))Not working63 (62.4%)
Handedness (no (%))Right98 (97.0%)
Left3 (3.0%)
Medical history (no (%))Medical problem (DM, HTN, IHD, AF, and MI)61 (60.4%)
Neurological problem2 (2.0%)
Medical and neurological problem (epilepsy, TIA, and migraine)21(20.8%)
Medication (no (%))Drug affecting cough (ACE inhibitors)23 (22.8%)
Drug not affecting cough41 (40.6%)
CVS TYPE (no (%))Arterial ischemic87 (86.1%)
Arterial hemorrhagic11 (10.9%)
Venous ischemic2 (2.0%)
Venous hemorrhagic1(1.0%)
CVS location (no (%))Right anterior circulation42 (41.6%)
Left anterior circulation39 (38.6%)
Right posterior circulation9 (8.9%)
Left posterior circulation11(10.9%)

  1. AF atrial fibrillations, ACE inhibitors angiotensin-converting enzyme inhibitor, DM diabetes mellitus, HTN hypertension, MI myocardial infarction, TIA transient ischemic attack