Oropharyngeal dysphagia in exacerbations of chronic obstructive pulmonary disease

Abstract

Objective To determine whether patients presenting to hospital with an acute exacerbation of chronic obstructive pulmonary disease (COPD) are more likely than controls to suffer from oropharyngeal swallow disorder. Design Prospective case-controlled survey. Setting Departments of general and geriatric medicine in a university teaching hospital. Participants Forty-one consecutive admissions with a primary diagnosis of acute exacerbation of COPD were compared with 41 emergency medical admissions with primary diagnoses other than COPD or neurological disease. Measures A swallow screening test and structured neurological examination. Patients who tested positive on the swallow test were referred for formal Speech and Language therapy assessment with videofluroscopic examination if clinically indicated. Results Of 41 patients with COPD, 23 (56%) had a positive swallow test, compared to 12 of 41 controls (29%, P < 0.05). On bedside assessment 18 COPD subjects were identified as “at significant risk for aspiration” and the remaining five had a functional swallow. Thirteen of the “risk for aspiration” group underwent videofluroscopy. This revealed aspiration in seven (17%) subjects and other abnormalities in six subjects (11%). By contrast two controls were assessed as “significant risk for aspiration”. Conclusion A significant proportion of patients who are hospitalized with an exacerbation of chronic obstructive airways disease have coexisting oropharyngeal swallow disorder. Oropharyngeal swallow disorder may contribute to or exacerbate their illness. The majority of this sub-group may recover a functional swallow with compensatory strategies. Oropharyngeal swallow disorder may represent a possible remediable factor in the management of some patients with chronic obstructive airways disease.