Clinical and fiberoptic endoscopic assessment of swallowing in patients with chronic obstructive pulmonary disease

Abstract

Summary Introduction: Chronic obstructive pulmonary disease is characterized by progressive and partially reversible obstruction of pulmonary airflow. Aim: To characterize swallowing in patients with chronic obstructive pulmonary disease and correlate the findings with the degree chronic obstructive pulmonary disease, heart and respiratory rate, oxygen saturation, and smoking. Method: We conducted a prospective cohort study of 19 patients (12 men and 7 women; age range, 50–85 years) with confirmed medical diagnosis of chronic obstructive pulmonary disease. This study was performed in 2 stages (clinical evaluation and functional assessment using nasolaryngofibroscopy) on the same day. During both stages, vital signs were checked by medical personnel. Results: Clinical evaluation of swallowing in all patients showed the clinical signs of cough. The findings of nasolaryngofibroscopy highlighted subsequent intraoral escape in 5 patients (26.5%). No patient had tracheal aspiration. There was no association of subsequent intraoral escape with degree of chronic obstructive pulmonary disease, heart and respiratory rate, oxygen saturation, or smoking. Conclusion: In patients with chronic obstructive pulmonary disease, there was a prevalence of oral dysphagia upon swallowing and nasolaryngofibroscopy highlighted the finding of subsequent intraoral escape. There was no correlation between intraoral escape and the degree of chronic obstructive pulmonary disease, heart and respiratory rate, oxygen saturation, or smoking.

Aspiration and severe exacerbations in COPD: a prospective study

“…Our previous [ 6 ] and other small studies [ 5 ] have suggested that aspiration is detectable in ∼25% of stable COPD, and two retrospective studies noted aspiration in up to 40% [ 7 , 8 ]. However, several other investigations failed to detect any evidence of aspiration in this patient group [ 19 , 27 – 29 ]. These differences are likely to reflect methodological variations including poorly characterised, small patient study groups, confounding by comorbidities (such as neurological and swallow impairment) and use of small volume or solid contrast materials and high liquid viscosity that may preclude detection of aspiration.…”

“…The current study recruited a larger cohort of patients with COPD compared to previous smaller studies [ 5 , 6 , 8 , 10 , 19 , 27 – 29 ]. Patients had stable, verified disease at baseline, conditions that may predispose to prandial aspiration were excluded and the volume of contrast material was optimised for accurate imaging by means of videofluoroscopy.…”

Desfechos da terapia manual sobre a biomecânica da deglutição em indivíduos com DPOC

“…A disfagia na doença pulmonar obstrutiva crônica (DPOC) tem sido foco crescente de pesquisas nos últimos anos, as quais evidenciam prejuízos na biomecânica da deglutição, sendo um importante fator de risco para pneumonias aspirativas e, consequentemente, exacerbações (1)(2)(3)(4)(5)(6)(7) . Estudo recente (8) demonstrou em uma amostra de 65 indivíduos com DPOC, que 25,5% apresentaram incoordenação entre respiração/deglutição, os quais realizaram a inspiração posterior a deglutição, aumentando os riscos de aspiração.…”

“…Além da inversão do padrão respiração/deglutição, outros comprometimentos específicos da deglutição têm sido relatados na literatura, como aumento no tempo de trânsito faríngeo (TTF) (5) , alteração no fechamento vestíbulo-laríngeo, menor excursão do osso hioide (6) , escape oral posterior, resíduos em valéculas (VL) (2) e alterações no disparo da deglutição (9) em diferentes consistências alimentares.…”

“…Uma das causas apontadas é o comprometimento da musculatura respiratória, a qual fica em desvantagem mecânica devido à hiperinsuflação pulmonar adotada por esses indivíduos. O recrutamento crônico da musculatura acessória da respiração, com consequente encurtamento das suas fibras, pode restringir o movimento hiolaríngeo (1)(2)(3)(4)(5)(6)(7) , podendo permanecer resíduos na faringe e levar a processos aspirativos (3) .…”