Breathing–swallowing discoordination is associated with frequent exacerbations of COPD

Nagami, Shinsuke; Oku, Yoshitaka; Yagi, Naomi; Sato, Susumu; Uozumi, Ryuji; Morita, Satoshi; Yamagata, Yoshie; Kayashita, Jun; Tanimura, Kazuya; Takahashi, Ryōsuke; Muro, Shigeo

doi:10.1136/bmjresp-2017-000202

Cited by 49 publications

(51 citation statements)

References 32 publications

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“…Our results differed from the previous reports, which stated that the SSPT results correlated with the history of COPD exacerbation . Patients with COPD are reported to present a characteristic change in the coordination of deglutition and respiration, which may contribute to their dysphagia . This unique pathophysiology of dysphagia may be the reason why dysphagia in patients with COPD is more pronounced in repetitive efforts such as the RSST, instead of a one‐time‐only reflection test such as the SSPT.…”

Section: Discussioncontrasting

confidence: 99%

“…3,4 Patients with COPD are reported to present a characteristic change in the coordination of deglutition and respiration, which may contribute to their dysphagia. 11 This unique pathophysiology of dysphagia may be the reason why dysphagia in patients with COPD is more pronounced in repetitive efforts such as the RSST, instead of a one-time-only reflection test such as the SSPT. The poor concordance between the results of SSPT and other screening tests (Table 5) also indicates the possibility that SSPT is not useful in the otherwise healthy COPD population.…”

Section: Discussionmentioning

confidence: 99%

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Repetitive saliva swallowing test and water swallowing test may identify a COPD phenotype at high risk of exacerbation

Yoshimatsu

Tobino

Sueyasu

et al. 2019

Clinical Respiratory J

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Introduction Patients with chronic obstructive pulmonary disease (COPD) are known to present with dysphagia from an early stage. Dysphagia leads to swallowing‐related complications, in turn leading to COPD exacerbation. Dysphagia screening is recommended; however little is known of its utility in detecting a COPD phenotype at risk for exacerbation. The simple swallowing provocation test (SSPT), considered to be a standard screening test, requires specific equipment, physician skill and patient discomfort. Objectives The aim of this study was to find an easier and less invasive measure to screen for dysphagia in patients with COPD. Methods We retrospectively reviewed patients with COPD who were screened for dysphagia [Repetitive saliva swallowing test (RSST), water swallowing test (WST), SSPT and a questionnaire] from June to November 2016. The patients were classified into two groups according to the presence of COPD exacerbation in the past 3 years (ie, exacerbation and non‐exacerbation group), and the dysphagia screening results were compared between the groups. Results Of the 80 cases included, 42 had 1 or more exacerbations in the past 3 years (exacerbation group), and 38 had none (non‐exacerbation group). Statistically significant differences between the groups were observed in the RSST, and vocal change in the WST (P < 0.05). There were no significant differences between the groups in the results of SSPT, COPD stage and other clinical status. Conclusions Compared to the SSPT, RSST and WST may be more appropriate screening methods in patients with COPD. A prospective study is necessary for further assessment.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Repetitive saliva swallowing test and water swallowing test may identify a COPD phenotype at high risk of exacerbation

Yoshimatsu

Tobino

Sueyasu

et al. 2019

Clinical Respiratory J

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“…The Bell's disease classification guidelines include the ability to reliably predict adverse clinical outcomes and patient responses to potential therapies . In this context, the KCL can extract detailed problems in various domains, such as activities of daily living, locomotor function, oral function, cognitive function and mental burdens, which tend to be underdiagnosed despite their importance in patients with COPD . Therefore, this model can be used to enable rapid and effective interventions for patients with COPD.…”

Section: Discussionmentioning

confidence: 99%

Comparison of three frailty models and a sarcopenia model in elderly patients with chronic obstructive pulmonary disease

Hirai

Tanaka

Homma

et al. 2019

Geriatrics Gerontology Int

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Aim: Frailty and sarcopenia affect the prognosis and quality of life of patients with chronic obstructive pulmonary disease (COPD). However, it remains uncertain which model is the most suitable for evaluating vulnerability in patients with COPD. We evaluated the validity of three frailty modelsthe Kihon Checklist (KCL), the Japanese version of the Cardiovascular Health Study and the Study of Osteoporotic Fracturesand one sarcopenia model for older patients with COPD.Methods: This cross-sectional study included 201 older (aged ≥65 years) outpatients with COPD. We used three frailty models and one sarcopenia model to identify their correlation with various indices that can evaluate the status of COPD and determine the most ideal model for evaluating vulnerability in patients with COPD.Results: The highest prevalence of frailty (38%) and lowest prevalence of robustness (26%) were observed using the KCL. Although all models reflected the characteristics of COPD, the KCL yielded the strongest correlations with clinically important physical, psychological and prognostic indices. The KCL yielded statistically significant differences in almost all indices among the three intergroup comparisons (robust, pre-frailty and frailty). The KCL was superior in extracting mood disorders to the other models.Conclusion: Although all investigated models were useful, the KCL was the most suitable for evaluating the frailty status and might enable interventions in patients with COPD.

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“…Indeed, an increase in I-SW pattern is associated with a risk of aspiration in Parkinson's disease (Troche et al, 2011 ). Recently, we reported that frequent I-SW and/or SW-I patterns (high I-SW/SW-I rate) exacerbated COPD (Nagami et al, 2017 ). Therefore, the identification of such subjects with a high I-SW/SW-I rate and treating them to reduce the I-SW/SW-I rate may prevent exacerbations of these diseases.…”

Section: Introductionmentioning

confidence: 99%

Inappropriate Timing of Swallow in the Respiratory Cycle Causes Breathing–Swallowing Discoordination

et al. 2017

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Rationale: Swallowing during inspiration and swallowing immediately followed by inspiration increase the chances of aspiration and may cause disease exacerbation. However, the mechanisms by which such breathing–swallowing discoordination occurs are not well-understood.Objectives: We hypothesized that breathing–swallowing discoordination occurs when the timing of the swallow in the respiratory cycle is inappropriate. To test this hypothesis, we monitored respiration and swallowing activity in healthy subjects and in patients with dysphagia using a non-invasive swallowing monitoring system.Measurements and Main Results: The parameters measured included the timing of swallow in the respiratory cycle, swallowing latency (interval between the onset of respiratory pause and the onset of swallow), pause duration (duration of respiratory pause for swallowing), and the breathing–swallowing coordination pattern. We classified swallows that closely follow inspiration (I) as I-SW, whereas those that precede I as SW-I pattern. Patients with dysphagia had prolonged swallowing latency and pause duration, and tended to have I-SW or SW-I patterns reflecting breathing–swallows discoordination.Conclusions: We conclude that swallows at inappropriate timing in the respiratory cycle cause breathing–swallowing discoordination, and the prolongation of swallowing latency leads to delayed timing of the swallow, and results in an increase in the SW-I pattern in patients with dysphagia.

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Breathing–swallowing discoordination is associated with frequent exacerbations of COPD

Cited by 49 publications

References 32 publications

Repetitive saliva swallowing test and water swallowing test may identify a COPD phenotype at high risk of exacerbation

Repetitive saliva swallowing test and water swallowing test may identify a COPD phenotype at high risk of exacerbation

Comparison of three frailty models and a sarcopenia model in elderly patients with chronic obstructive pulmonary disease

Inappropriate Timing of Swallow in the Respiratory Cycle Causes Breathing–Swallowing Discoordination

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