Oropharyngeal swallow physiology and swallowing-related quality of life in underweight patients with concomitant advanced chronic obstructive pulmonary disease

Abstract

BackgroundSwallowing impairment (dysphagia) has been associated with COPD and may contribute to exacerbations of this chronic and progressive disease. Further, risk of mortality increases with concomitant presence of cachexia in the COPD population. The purpose of this prospective study was to depict oropharyngeal swallowing physiology in underweight patients with stable but advanced-stage COPD.Patients and methodsTen underweight patients with stable but advanced COPD underwent a modified barium swallow study. Analysis of oropharyngeal swallowing function was completed using the standardized Modified Barium Swallow Impairment Profile and the Penetration–Aspiration Scale. Scores from the Dysphagia Handicap Index and 10-item Eating Assessment Tool were collected to assess patient perception of swallowing difficulty. Findings were compared to age- and sex-matched healthy controls.ResultsSignificantly higher MBSImP oral total scores (P=0.007) were observed in COPD patients compared to matched controls, but no difference was observed in pharyngeal total scores (P=0.105). Patients with COPD had significantly higher maximum PAS scores compared with controls (P=0.030). There was no significant difference in EAT-10 or DHI scores between patients with COPD and controls (P=0.41 and P=0.08, respectively).ConclusionUnderweight patients with severe but stable COPD present with dysphagia that may not be recognized by the patient. Further investigation is needed to elucidate the interaction between the respiratory–swallowing systems, how muscular weakness may contribute to swallowing impairment, and responsiveness to swallowing treatment.

Aspiration and severe exacerbations in COPD: a prospective study

“…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.…”

“…Prandial aspiration refers to aspiration that occurs during swallow, as distinct from retrograde aspiration (associated with reflux), microaspiration (involving small amounts of oropharyngeal or gastro-oesophageal contents) or silent aspiration (absence of cough despite material present below the vocal folds) [ 2 ]. Aspiration associated with swallow is particularly important due to its associated increased risk of pneumonia [ 3 , 4 ], yet investigations into the condition in patients with COPD are rare or describe swallowing dysfunction of a different nature [ 5 – 10 ]. Limited data from small studies involving an array of methodologies to detect prandial aspiration suggest the condition may occur in up to 25% of patients with stable COPD [ 5 , 6 ].…”

Swallowing dysfunction in patients hospitalised due to a COPD exacerbation

“…The 10-Item Eating Assessment Tool (EAT-10) [10] is a widely used questionnaire for selfreported (subjective) dysphagia and has been translated and validated in many language including Swedish. It has been used previously with this patient group [15][16][17]. It consists of 10 statements where patients are asked to rate themselves on a 5-point scale for severity for each statement (Table 3).…”

Chronic Obstructive Pulmonary Disease and Dysphagia: A Synergistic Review

“…While the exact prevalence of dysphagia among individuals with COPD is unknown [16], COPD disrupts the typical coordination between the swallowing and respiratory systems, leading to impairments and inefficiencies in the swallowing process [17][18][19]. Dysphagia symptomatology is present even in individuals with mild COPD [20], although swallowing difficulties are not always recognized or self-reported as an issue [21]. Among nursing home residents, COPD has been found to be the second strongest predictor for aspiration pneumonia, which is also linked to dysphagia [22].…”