Oropharyngeal swallowing physiology and safety in patients with Idiopathic Pulmonary Fibrosis: a consecutive descriptive case series

Abstract

Introduction Dysphagia occurs in multiple respiratory pathophysiologies, increasing the risk of pulmonary complications secondary to aspiration. Reflux associated aspiration and a dysregulated lung microbiome is implicated in Idiopathic Pulmonary Fibrosis (IPF), but swallowing dysfunction has not been described. We aimed to explore oropharyngeal swallowing in IPF patients, without known swallowing dysfunction. Methods Fourteen consecutive outpatients with a secure diagnosis of IPF were recruited and the 10-item Eating Assessment Tool (Eat 10) used to assess patient perception of swallowing difficulty. Oropharyngeal swallowing was assessed in ten patients using Videofluoroscopy Swallow Studies (VFSS). The studies were rated using validated scales: Penetration-Aspiration Scale (PAS); standardised Modified Barium Swallow Impairment Profile (MBSImP). Results EAT-10 scores indicated frank swallowing difficulty in 4/14 patients. Videofluoroscopy Studies showed that 3/10 patients had airway penetration, and one aspirated liquid without a cough response. Median MBSImp for oral impairment was 5, range [3–7] and pharyngeal impairment 4, range [1–14] indicating, overall mild alteration to swallowing physiology. Conclusion We conclude that people with IPF can show a range of swallowing dysfunction, including aspiration into an unprotected airway. To our knowledge, this is the first report on swallowing physiology and safety in IPF. We believe a proportion of this group may be at risk of aspiration. Further work is indicated to fully explore swallowing in this vulnerable group.

Eating and drinking experience in patients with idiopathic pulmonary fibrosis: a qualitative study

“…We have previously provided quantitative data showing that dysregulated swallowing physiology can occur in patients with IPF, which included fluoroscopic evidence of aspiration. 14 Non-sterile aspiration represents a candidate source of complex lung injury and microbiome dysregulation and the present study provides novel complimentary information that provides qualitative data regarding eating and drinking in patients with IPF.…”

“…These studies have identified issues with patients obtaining a correct and timely diagnosis; accessing suitable information about their condition; and substantial physical and psychosocial impacts on themselves and carers, affecting their overall Ouality of Life (QOL) 10 13. We have also published preliminary work which noted that around a third of patients with IPF reported difficulties with eating and drinking using a patient-reported measure 14. Further qualitative work is warranted to understand this problem in more depth.…”

“… 10 13 We have also published preliminary work which noted that around a third of patients with IPF reported difficulties with eating and drinking using a patient-reported measure. 14 Further qualitative work is warranted to understand this problem in more depth.…”