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The laryngeal cough reflex (LCR) is a new screening test which may be available in the next year. It is currently going through FDA approval. This is a test which examines risk for pneumonia based upon whether or not a patient coughed immediately in response to inhalation of a mixture of tartaric acid and sterile water from a nebulizer.

The test can be appropriately done by speech-language pathologists. It should be done by one of us in the context of our bedside examination for swallow function. If the test is done by someone else it is likely to be misinterpreted as a swallowing test. The LCR tells us nothing about swallow physiology, ability to handle enough food and liquid to prevent malnutrition and dehydration. To be truly useful, the test should be imbedded in our bedside assessment. The risk, of course, is that the patient will receive an LCR test and nothing else which is why it's critical that we perform the test and place it in the context of the remainder of the patient's information on swallowing.

In communicating with physicians about this LCR test, we should emphasize:

• The LCR is a new strategy to add to our bedside swallow assessment
• The LCR does not examine swallowing
• The LCR looks at pneumonia risk in stroke patients
• The LCR has only been validated in stroke patients
• In order to prevent malnutrition and dehydration in stroke patients, a patient needs a full swallow evaluation
• The LCR is only a small piece of swallow assessment
• The LCR tells us nothing about what kind of swallowing therapy the patient needs. We cannot plan therapy from an LCR.

It is important that we "take ownership" of the LCR test in acute care and in rehabilitation.

The test involves placing a 20% mixture of tartaric acid and sterile water into a nebulizer and bringing it to the patient's mouth to breathe. The patient's nares are blocked by the SLP conducting the test. The patient is told to inhale deeply through the nebulizer. The immediate result should be a strong cough to clear away the nebulized tartaric acid. There are several references which found that not coughing in response to the tartaric acid has a strong relationship with development of pneumonia. In fact, failure to cough with the tartaric acid nebulized is a strong predictor of those stroke patients who will get pneumonia if fed. The LCR does not tell us what treatment to provide if the patient is an inefficient swallower or an unsafe swallower.