Optimal Patterns of Care in Patients with Chronic Obstructive Pulmonary Disease

Abstract

An intimate relationship exists between the physiological processes of respiration and swallowing at all levels of neuromotor control and peripheral function in healthy adults. Little is known regarding the potential alterations in these patterns in patients with chronic obstructive pulmonary disease (COPD), yet the impact of swallowing impairment and aspiration on the health outcomes of patients with COPD may be significant. COPD is a common comorbidity in patients with head and neck cancer and neurological disorders seen by swallowing clinicians, and warrants consideration during swallowing treatment. This article summarizes reports of alterations in the nutritional status, airway protective mechanisms, and swallowing efficiency that potentially contribute to or exacerbate the chronic and debilitating pulmonary condition. Care guidelines are given for modification of eating and swallowing behavior to optimize the health status of the patient with COPD. The need for controlled clinical trials for validation of the impact of these care guidelines on clinical outcomes is explained.

Coordination of Pharyngeal and Laryngeal Swallowing Events During Single Liquid Swallows After Oral Endotracheal Intubation for Patients with Acute Respiratory Distress Syndrome

“…This duration was nearly double that of healthy volunteers, placing patients at increased risk for entrance of liquids and solid food into the airway before the swallow begins and as the swallow continues through full closure of the larynx. Notably, only 1 (9%) of the 11 ARDS patients aspirated the 5-ml thin liquid bolus, suggesting that factors other than timing of swallowing are associated with aspiration in ARDS patients after extubation (e.g., sensation, 47 respiratory-swallow coordination 48,49 ). Although there was no difference in the duration of laryngeal closure, ARDS patients were delayed in re-opening their airway after the swallow.…”

Clinical Practice Patterns of Speech-Language Pathologists Delivering Dysphagia Services to Persons with COPD: Analysis of Survey Outcomes

“…Although the body of literature related to symptoms and pathophysiology in PwCOPD with dysphagia is growing, current speechlanguage pathology (SLP) clinical practice patterns in this area are unknown. Similar to dysphagia practice patterns in other populations, [26][27][28] Martin-Harris et al 29 advocated that team-based assessment and management is imperative for the determination of respiratory influence on swallow and ensuring dysphagia did not worsen the respiratory disease. Clinical symptoms in PwCOPD, such as dyspnea, fatigue, anxiety, and hypoxia (reduced oxygen), warrant consideration during the SLP's swallowing assessment and treatment due to the influence these symptoms may have on a PwCOPD's swallowing function.…”

Nasal airflow monitoring during swallowing: Evidences for respiratory-swallowing incoordination in individuals with chronic obstructive pulmonary disease

“…Martin-Harris concluded that patients attempting to maintain breathing activity as long as possible before the obligatory apneic pause, and trying to reestablish respiration quickly while eating semisolids and solids may present channeling of a bolus to the level of the pyriform sinuses and premature opening of the larynx during the latter stages of swallow. [6] The habitual and sometimes necessary mouth-breathing characteristics of COPD patients may lead to excessive dryness and adherence of thick and dry materials to the oropharyngeal tissues, with potential postswallow aspiration.…”