Cough According to Stimulus Type in PD
Condition: Parkinson's Disease
MeSH terms: Parkinson Disease
Study type: Interventional
Phase: Phase 1

Summary: 
      Aspiration pneumonia (APn) occurs at a higher rate in patients with Parkinson's disease (PD)
      versus healthy adults. This is of particular public health concern given that death secondary
      to aspiration pneumonia and lung infection is a leading cause of death in persons with PD.
      Swallowing and cough function are affected in PD, putting people with PD at significant risk
      for uncompensated aspiration (aspiration without adequate cough response). One challenge in
      the management of airway protective deficits related to PD is the chronic and progressive
      nature of the disease, where swallowing dysfunction appears subtly in the form of
      microaspiration, reducing the perceived urgency of the swallowing disorder by both clinicians
      and patients. The long-term goal of this research is to advance the management of airway
      protection deficits in patients with neurodegenerative disease in order to decrease morbidity
      and mortality due to aspiration related lung infection. The objective here is to further
      specify deficits leading to uncompensated airway compromise in PD in order to advance the
      clinical management of these patients, leading to an immediate positive impact.
    

Detailed description: 
      The study will be completed in one visit, and take about an hour. All study procedures are
      done in the investigators quiet clinical research area at the Center for Movement Disorders
      and Neurorestoration (Room 7). If participants agree to be in this research study, after
      participants sign the informed consent form, the investigators will ask participants some
      questions related to participants health history. These questions include:

      Do participants have a history of any breathing disorders or diseases (asthma,
      emphysema/chronic obstructive pulmonary disease (COPD), etc), or severe chest injury?

        -  Do participants have any history of stroke, or any neurologic disease besides
           Parkinson's disease?

        -  Have participants smoked in the last 5 years?

        -  Have participants had any chest infections within the last 5 the weeks?

        -  Do participants have a history of head and neck cancer?

        -  Are participants allergic to capsaicin, hot peppers, Zostrix cream, or other medicines?

      The investigators will ask these questions to make sure participants do not have a history of
      any illnesses that would affect their ability to cough or that would make it unsafe for them
      to participate. If participants answer yes to any of these questions, they will not be able
      to continue in the study.

      Next, the investigators will begin to measure participants reflex cough. First, the
      investigators will attach a small microphone with a clip to participants shirt that will
      record participants cough responses. The investigators will have participants inhale a "hot
      pepper" vapor at five different concentrations. The hot pepper vapors will be separately
      delivered through a mouthpiece attached to a hand-held nebulizer (a device that makes vapors
      out of liquids). The investigators will deliver each type of vapor to participants 3 times
      each for a total of 15 presentations. After inhaling each vapor and coughing if participants
      need to, the investigators will ask participants to rate their urge to cough using a scale of
      0-10, with 0 equaling no urge to cough, and 10 equaling the greatest urge to cough. If
      participants do not cough to any of the vapors, the investigators will present one final
      stronger dose. There will be a 2 minute break in between each presentation of the vapor, and
      water will be available at all times throughout the study. This will take approximately 40
      minutes.

      Next, the investigators will continue to measure participants reflex cough using a slightly
      different test. The investigators will have participants inhale water vapor (fog) and a low
      concentration of hot pepper vapor. Both types of vapor will be in separate nebulizers, like
      the ones the investigators just used. For these vapors, participants will breathe in and out
      through the nebulizer's mouthpiece until participants cough, or for up to 1 minute. The
      investigators will try each one 3 times, for a total of 6 tries.
    

Intervention name(s): Capsaicin vapor; fog; Videofluoroscopic swallow evaluation; Nebulizer
Intervention type(s): Drug; Other; Radiation; Device
Intervention description(s): Single-breath and continuous inhalation paradigm to induce cough.; Continuous inhalation of fog until a cough is produced, or up to 60 seconds (whichever is shortest); Fluoroscopic evaluation of oropharyngeal swallowing function.; A hand-held nebulizer will be used to aerosolize the capsaicin and water solutions. Participants will inhale through the device's mouthpiece, and cough if they need to.
Other intervention name(s): hot pepper vapor; aerosolized water; Swallow study; Modified barium swallow study
Intervention MeSH terms: Capsaicin
Allocation: Non-Randomized
Intervention model: Single Group Assignment
Masking: Single (Participant)
Primary purpose: Diagnostic
Keywords: Dysphagia; Cough; Aspiration pneumonia