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Objective: To establish how oral bacteria are related to cough sensitivity and pneumonia in a clinical stroke population. Background: Stroke patients are at risk of colonisation by respiratory pathogens due, in part, to sudden discontinuation of effective oral hygiene. When combined with reduced cough reflex sensitivity, aspiration of contaminated oropharyngeal contents and can lead to pneumonia. Relationships between oral bacteria, cough sensitivity and pneumonia have not been established. Materials and methods: A total of 102 patients with acute stroke underwent saliva sampling and cough reflex testing at admission to hospital, discharge and one month. A qPCR assay compared levels of bacteria in saliva. Pneumonia events were recorded. Results: Relative levels of bacteria were lowest at admission to hospital (6.04 × 10−6). There was a slight (non‐significant) increase in bacterial levels at discharge (1.69 × 10−2, P =.73). By one month, bacterial levels had significantly increased (9.17 × 10−2) relative to admission [P <.001] and discharge [P <.001]. Pseudomonas aeruginosa, Klebsiella pneumoniae and Escherichia coli are not typically found in healthy mouths, yet were detected in 22% of patients during hospitalisation. Combined bacterial levels measured at one month was associated with pneumonia (P =.004) but there was no relationship to cough sensitivity. Conclusion: Acute stroke patients were at increased risk of colonisation from respiratory pathogens throughout their recovery. The presence of these pathogens in saliva at one month was associated with adverse respiratory events. Data support the development of protocols to explore risk factors and sequelae of microbiological changes in stroke. [ABSTRACT FROM AUTHOR]

Objectives: When swallowing function is compromised in patients with Parkinson's disease (PD), cough plays a crucial role in clearing the airway and preventing pulmonary complications. The aim of this study was to determine the influence of vocal fold atrophy severity as measured by the bowing index (BI) on airway protection in PD.Methods: Thirty participants with PD completed measures of voluntary and reflex cough. Flexible laryngoscopy with endoscopic evaluation of swallowing allowed for measurement of BI using ImageJ software. Swallowing safety was scored on the Penetration-Aspiration Scale (PAS). Regression and receiver operating characteristic (ROC) analyses were performed to test our study aim.Results: Twenty-four of 30 participants had some degree of vocal fold atrophy (BI >0). When controlling for age, disease duration did not significantly influence BI. BI was not predictive of any sensorimotor parameters of cough including measures of cough airflow, reflex cough threshold, or urge to cough. BI discriminated participants with near-normal (PAS 1-3) swallowing safety from participants with impaired (PAS 4-8) swallowing safety (P = .01, sensitivity: 87.0%, specificity: 71.4%, cutoff value BI >4.6).Conclusion: Vocal fold atrophy is a potential factor contributing to poor swallowing safety in PD. BI was not associated with cough function in this PD cohort, contrary to prior studies that have shown improved cough measures after vocal fold augmentation. Vocal fold atrophy in PD remains an important area of study as a targetable intervention for patients with airway protective dysfunction. Future studies should include measures of glottic closure during vocal fold adduction.Level Of Evidence: Level 3 Laryngoscope, 130:303-308, 2020. [ABSTRACT FROM AUTHOR]

Endotoxin exacerbates asthma. We designed the Louisa Environmental Intervention Project (LEIP) and assessed its effectiveness in reducing household endotoxin and improving asthma symptoms in rural Iowa children. Asthmatic school children (N = 104 from 89 homes) of Louisa and Keokuk counties in Iowa (aged 5‐14 years) were recruited and block‐randomized to receive extensive (education + professional cleaning) or educational interventions. Environmental sampling collection and respiratory survey administration were done at baseline and during three follow‐up visits. Mixed‐model analyses were used to assess the effect of the intervention on endotoxin levels and asthma symptoms in the main analysis and of endotoxin reduction on asthma symptoms in exploratory analysis. In the extensive intervention group, dust endotoxin load was significantly reduced in post‐intervention visits. The extensive compared with the educational intervention was associated with significantly decreased dust endotoxin load in farm homes and less frequent nighttime asthma symptoms. In exploratory analysis, dust endotoxin load reduction from baseline was associated with lower total asthma symptoms score (Odds ratio: 0.52, 95% confidence interval: 0.29‐0.92). In conclusion, the LEIP intervention reduced household dust endotoxin and improved asthma symptoms. However, endotoxin reductions were not sustained post‐intervention by residents. [ABSTRACT FROM AUTHOR]

The kinetic Limulus amebocyte lysate (LAL) assay and the recombinant factor C (rFC) assay are used for comparing airborne endotoxin concentrations in laboratory- and field-collected parallel air samples. Mixed-model analysis of variance (ANOVA) for the field studies has showed major interactions of facility-sampler and facility-assay and the studies have shown that the LAL assay and rFC assay have returned similar estimates of exposure in livestock facilities.