Objective: To establish the feasibility of using portable handheld equipment to identify aspiration risk among people with Parkinson’s disease in a rural Northern Tanzanian population (Hai district).

Background: Pneumonia is among the leading causes of death of people with Parkinson’s (PwP) [1]. This is primarily due to cough weakness and impairment of swallow increasing aspiration risk. In Hai district, PwP have limited access to health care and formal assessments of respiratory and swallow function. Cough peak flow (CPF) and maximum inspiratory and expiratory pressures (MIPs/MEPs) are established tools to assess neuromuscular function contributing to aspiration risk and can be readily tested using handheld devices. Establishing the practicality and applicability of these assessment tools to this population will allow local healthcare teams to use limited resources effectively to support those at highest risk of aspiration pneumonia.

Method: 28 participants diagnosed with Parkinson’s disease, enrolled in the Transforming Parkinson’s Care in Africa study in Hai district, were consented to undergo additional assessments. Assessments were done in or near their own homes including MIPs, MEPS (micro Respiratory Pressure Meter), CPF (face mask and peak flow meter), a simple swallow assessment (drinking 150 mL water, recording number of swallows, time taken and signs of aspiration risk; coughing or wet voice after test), respiratory infection history and MDS-UPDRS (Unified Parkinson’s Disease Rating Scale) among others.

Results: Assessing MIPs/MEPs was challenging due to poor cognition and mouth seal. 5/28 were unable to complete the assessment and several more did not achieve a consistent reading. CPF and the simple swallow assessment were straightforward for participants to perform. 10/27 (35%) participants had a low CPF (<160 L/min) [2] indicating increased aspiration risk. 5/10 with a low CPF had clinical signs of aspiration risk vs 0/17 with a normal CPF (Fisher’s exact test p=0.003). Higher UPDRS motor scores were associated with lower CPF (r= −0.406, p= 0.036) and longer swallowing time (r= 0.46, p= 0.014) but had no association with number of swallows.

Conclusion: This feasibility study demonstrates that CPF and a simple swallow assessment are practical tools to employ in a rural, low-resource setting, to establish aspiration risk and could be valuable additions to existing care.

References: [1] Pennington S, Snell K, Lee M, Walker R. The cause of death in idiopathic Parkinson’s disease. Parkinsonism Relat Disord. 2010 Aug;16(7):434-7. doi: 10.1016/j.parkreldis.2010.04.010. Epub 2010 May 31. PMID: 20570207.
[2] Laveneziana P, Albuquerque A, Aliverti A, et al. ERS statement on respiratory muscle testing at rest and during exercise. Eur Respir J. 2019;53(6):1801214. Published 2019 Jun 13. doi:10.1183/13993003.01214-2018

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MDS Abstracts - https://www.mdsabstracts.org/abstract/pilot-feasibility-study-of-home-based-assessment-of-aspiration-risk-among-people-with-parkinsons-disease-in-rural-northern-tanzania/