Oropharyngeal Dysphagia with Aspiration as a Provoking Factor for COPD Exacerbation

Noor Sameh Darwich

doi:10.11648/j.ajim.20190701.14

Abstract

The most common provoking factors for chronic Obstructive Pulmonary Disease (COPD) exacerbation include viral and bacterial tracheobronchitis, pneumonia, and exposure to environmental irritants and air pollution. In many patients with COPD exacerbation, the underlying cause cannot be identified. In general, patients with COPD exacerbation get admitted to the hospital and treated with antibiotics, glucocorticoids and inhaled bronchodilators. Oropharyngeal dysphagia is an under-recognized provoking factor for COPD exacerbation. Patients with advanced COPD often have impaired coordination of respiration and deglutition which can lead to aspiration of liquids, food particles, and saliva into the airways. Aspiration events can lead to exacerbation of symptoms and cause further decline in lung function. We described a 69-year-old male with a history of COPD who presented with progressive dyspnea, productive cough and hypoxia which required intubation and mechanical ventilation. The patient underwent a bronchoscopy for airway inspection which showed pieces of meat in the right main bronchus which were removed. Reportedly, the patient was having difficulty swallowing solid food prior to admission to the hospital.

Highlights

Swallowing dysfunction in patients with advanced chronic Obstructive Pulmonary Disease (COPD) is a common finding [1]
Repeated aspiration can lead to serious sequela in COPD patients including pneumonia, infection, worsening lung function and even death [3]
We detail the case of a patient with COPD exacerbation due to swallowing dysfunction and aspiration of meat particle into the airways, requiring intubation and mechanical ventilation support

Summary

Introduction

Swallowing dysfunction in patients with advanced COPD is a common finding [1]. Postprandial aspiration of food particles and more commonly liquids into the airways can lead to COPD exacerbation. Repeated aspiration can lead to serious sequela in COPD patients including pneumonia, infection, worsening lung function and even death [3]. We detail the case of a patient with COPD exacerbation due to swallowing dysfunction and aspiration of meat particle into the airways, requiring intubation and mechanical ventilation support. Aspiration was confirmed in this patient via bronchoscopy with removal of the food particles from the right main bronchus. Oropharyngeal aspiration should be in the differential diagnoses of patients with COPD exacerbations in those with advanced COPD and frequent exacerbations without obvious provoking factors [4]. If silent aspiration is suspected, an objective assessment such as a Video fluoroscopy should be performed

Case Report

Findings

Discussion

Conclusion