<p>Breathing–Swallowing Discoordination and Inefficiency of an Airway Protective Mechanism Puts Patients at Risk of COPD Exacerbation</p>

Abstract

Introduction: Dysphagia is a newly acknowledged multifactorial risk factor for the exacerbation of chronic obstructive pulmonary disease (COPD). Effective screening methods are awaited. We performed a prospective study to evaluate the impact of musculature and breathing-swallowing discoordination on the exacerbation of COPD with a novel swallowing monitor using a piezoelectric sensor. Patients and Methods: This was the second part of a prospective study of patients with COPD from the Iizuka COPD cohort. Seventy patients with stable COPD underwent dysphagia screening, skeletal muscle mass index (SMI) and tongue pressure measurements, and swallowed 3 mL and 30 mL of water while wearing a swallowing monitor. Patients were followed for one year. Results: During the follow-up period, 28 patients experienced exacerbations (E group), and 42 had none (non-E group). There was no significant difference in tongue pressure measurements between the two groups. The SMI in the E group was significantly lower than that in the nonE group. Among the swallowing monitor measurements, the 3 mL I-SW% (the percentage of swallows in which inspiration preceded the swallow [out of ten 3 mL swallows]) was significantly lower in the E group than in the nonE group. Conclusion: Breathing-swallowing coordination is an independent factor related to the exacerbation of COPD. Not only the presence of discoordination but also the inability to produce an airway protection mechanism may contribute to more frequent aspiration and exacerbations.

Dysphagia in non-intubated patients affected by COVID-19 infection

“…Cassiani et al highlighted that patients with COPD have an increased prevalence of oropharyngeal dysphagia as a consequence of impaired respiration and swallowing coordination function [ 14 ]. In addition to altered respiratory–swallow coordination patterns, oral and pharyngeal stasis, delayed swallow reflex, reduced laryngeal elevation, cricopharyngeal dysfunction, prolonged duration of hyoid bone, prolonged laryngeal vestibule closure and increased frequency of compensatory protective swallow maneuvers have also been reported as features of swallowing in COPD [ 14 – 16 ]. Among other things, atrophy and weakness of the respiratory muscles are commonly seen even in COPD [ 15 ].…”

“…Our findings suggest that COVID-19-induced lung injury rapidly worsens previous pulmonary pathology effects. This worsening has usually a rapid onset, hindering the spontaneous development of compensatory mechanisms needed to efficiently counterbalance the development of respiratory dysphagic symptoms, such as prolonged airway closure and earlier laryngeal closure [ 16 ] and pairs with worsening of the patients’ general conditions, in association with COVID-19-induced muscle fatigue and sarcopenia [ 17 , 18 ]. Moreover, bolus aspiration into the airway may contribute to additional worsening of the respiratory condition, leading to a vicious circle.…”

Interferential Current Stimulation for Swallowing Disorders in Chronic Obstructive Pulmonary Disease: A Preliminary Study

“…In patients with COPD, the unique changes in breathing–swallowing coordination puts them at risk of aspiration. 2 ) Whereas swallowing usually occurs during exhalation, patients with COPD tend to inhale before or after the swallow, which risks residue and oral microbiota being aspirated. Aspiration should be prevented as much possible in these patients because their lung capacities are already compensated.…”

“…It is known that breathing–swallowing coordination is affected in COPD patients and, in addition to the effects of tobacco smoking, lung hyperinflation, aging, sarcopenia, gastroesophageal reflux disease, and dry mouth, breathing–swallowing coordination is likely an important factor related to swallowing disorders in these patients. 1 , 2 ) Dysphagia is increasingly recognized as a critical phenotype in COPD that is prone to exacerbation. 3 ) In our previous study, we investigated the efficacy of the repetitive saliva swallowing test (RSST) in screening for COPD patients who are at risk of exacerbation.…”

Swallowing Dynamics and Breathing-Swallowing Coordination Are Altered in Patients with Mild Cognitive Impairment

“…Inspiration after swallowing and shorter swallowing apnea duration predispose patients with Parkinson's disease to aspiration/laryngeal penetration [3]. On the other hand, inspiration before swallowing is associated with longer swallowing apnea [4], and an increased frequency of inspiration before swallowing is associated with fewer exacerbations in patients with COPD [5]. Therefore, inspiration before swallowing may be an airway protective behavior to compensate for the delayed onset of swallowing [6].…”