<p>Effects of noninvasive ventilation on the coordination between breathing and swallowing in patients with chronic obstructive pulmonary disease</p>

Abstract

Purpose As shown in our previous study, inspiration after swallowing (SW-I) increases during the bi-level positive airway pressure ventilation (BiPAP) in healthy subjects because swallowing-associated non-inspiratory flow (SNIF) triggers inspiratory support, while SW-I during continuous positive pressure ventilation (CPAP) is rare. In the present study, we evaluated the coordination between breathing and swallowing during spontaneous breathing, BiPAP, and CPAP in patients with chronic obstructive pulmonary disease (COPD). Patients and methods This study is a prospective intervention study at the Hoshigaoka Medical Center (November 01, 2015–April 30, 2018). We simultaneously recorded the respiratory flow, laryngeal motion, and swallowing sounds during saliva swallowing in patients with COPD. We estimated the respiratory phase after swallowing, frequency of SNIF, the duration of the respiratory pause during swallowing, and timing of swallowing in the respiratory cycle and compared these parameters among control, CPAP, and BiPAP conditions. Results The expiration after swallowing (SW-E) frequency was associated with the occurrence of SNIF ( p <0.01), pause duration ≤0.8 s ( p <0.01), and timing of swallowing at the intermediate respiratory phase (50–80% of the respiratory cycle from the onset of inspiration) ( p <0.01). In particular, the occurrence of SNIF most substantially affected the SW-E frequency. The SW-I frequencies under the control, CPAP, and BiPAP conditions were 35.0%, 3.0%, and 37.7%, respectively. The pause durations were shorter during CPAP and BiPAP than under the control condition ( p <0.01). During CPAP, the occurrence rates of SW-E. Residual denotes the percentage difference between observed and expected values (residual =10.8: p <0.01) and SNIF (residual =9.1: p <0.01) were significantly increased, and timing of swallowing shifted toward the intermediate respiratory phase (residual=3.5: p <0.01). Conclusion CPAP decreases the SW-I frequency, increases the SNIF occurrence, and normalizes the timing of swallowing, all of which suggest that CPAP alleviates the risk of aspiration in patients with COPD.

How to eat, drink and speak on non-invasive ventilation

“…The median (range) number of words between breaths was 5 (4-7) for the neuromuscular subjects on NIV, significantly fewer than 11 (8)(9)(10)(11)(12)(13) for the matched control subjects.…”

Effects of high flow nasal cannula on the coordination between swallowing and breathing in postextubation patients, a randomized crossover study

“…MWST, modified water swallowing test; EMG, electromyography; HFNO, high flow nasal oxygen; LFNO, low flow nasal oxygen; ml, milliliters; min, minute; LPM, liters per minute test, the mean expiratory time in one minute was significantly longer in the HFNO group (41.5 ± 4.0 s in HFNO vs 39.2 ± 2.9 s in LFNO, p < 0.001). However, there was no difference in the respiratory rate (19.5 [17,21] rates per minute (rpm) in HFNO vs 20 [18,24] rpm in LFNO, p = 0.068) during the swallowing test (Table 2).…”

“…Furthermore, the lower subglottic pressure slowed pharyngeal transit time in tracheostomized patients, potentially contributing to pharyngeal residue accumulation and aspiration [ 19 , 20 ]. HFNO, on the other hand, produced positive airway pressure, which enhanced subglottic pressure and may have improved swallowing efficiency [ 21 ].…”

Decreased Tongue Strength is Related to Skeletal Muscle Mass in COPD Patients

“…Patients with either the I-SW pattern or the SW-I pattern were associated with a higher frequency of exacerbation [ 29 ]. A recent study showed the effectiveness of continuous positive pressure ventilation (CPAP) to decrease SW-I frequency and normalize the timing of swallowing [ 30 ]. While this discoordination has been well evaluated, tongue strength in COPD patients had yet to be evaluated.…”