Abstract
PurposeDysphagia is a serious extra pulmonary manifestation of chronic obstructive pulmonary disease (COPD). However, the nature of abnormalities in swallowing physiology in COPD has yet to be clearly established. We explored the frequency of swallowing measures outside the healthy reference range in adults with COPD.MethodParticipants were 28 adults aged 41–79 years (18 men, 20 women) with stable COPD. Disease severity was classified as GOLD (Global Initiative For Chronic Obstructive Lung Disease) Stages 1 (4%), 2 (25%), 3 (53%), and 4 (18%). Participants underwent a videofluoroscopy and swallowed 20% w/v thin barium in, followed by 20% w/v mildly, moderately, and extremely thick barium prepared with a xanthan gum thickener. Blinded duplicate ratings of swallowing safety, efficiency, kinematics, and timing were performed according to the ASPEKT method (Analysis of Swallowing Physiology: Events, Kinematics and Timing). Comparison data for healthy adults aged < 60 years were extracted from an existing data set. Chi-square and Fisher's exact tests compared the frequencies of measures falling < 1 SD/ > 1 SD from mean reference values (or < the first or > the third quartile for skewed parameters).ResultsParticipants with COPD did not display greater frequencies of penetration–aspiration, but they were significantly more likely (p < .05) to display incomplete laryngeal vestibule closure (LVC), longer time-to-LVC, and shorter LVC duration. They also displayed significantly higher frequencies of short upper esophageal sphincter opening, reduced pharyngeal constriction, and pharyngeal residue.ConclusionThis analysis reveals differences in swallowing physiology in patients with stable COPD characterized by impaired safety related to the mechanism, timing, and duration of LVC and by impaired swallowing efficiency with increased pharyngeal residue related to poor pharyngeal constriction.
Highlights
Chronic obstructive pulmonary disease (COPD) represents an important public health concern, comprising the fourth most common cause of mortality worldwide, and is expected to become the third most common cause of mortality by the end of 2020
Chronic recruitment of the accessory muscles of respiration in pulmonary hyperinflation may serve as an antagonist factor that restricts hyolaryngeal movement (Steidl et al, 2015; Yawn, 2013). This may contribute to poor laryngeal vestibule closure (LVC), reduced upper esophageal sphincter (UES) opening, and pharyngeal residue, all of which increase the risk of penetration and aspiration (Cvejic et al, 2011; Park et al, 2010)
Other aspects of swallowing that were reported to be impaired in 50% or more of the chronic obstructive pulmonary disease (COPD) cohort included MBSImP Components 2: tongue control during bolus hold (50%), 3: bolus preparation/mastication (70%), 5: oral residue (100%), 6: initiation of the pharyngeal swallow (100%), 7: soft palate elevation (50%), 11: LVC (50%), 14: pharyngoesophageal segment opening (90%), 15: tongue base retraction (100%), 16: pharyngeal residue (100%), and 17: esophageal clearance (100%)
Summary
Chronic obstructive pulmonary disease (COPD) represents an important public health concern, comprising the fourth most common cause of mortality worldwide, and is expected to become the third most common cause of mortality by the end of 2020 Research regarding dysphagia in COPD suggests that risk factors for aspiration are commonly present (Cassiani et al, 2015; Chaves et al, 2014; Clayton et al, 2014; Macri et al, 2013; Steidl et al, 2015). Chronic recruitment of the accessory muscles of respiration in pulmonary hyperinflation may serve as an antagonist factor that restricts hyolaryngeal movement (Steidl et al, 2015; Yawn, 2013) This may contribute to poor LVC, reduced upper esophageal sphincter (UES) opening, and pharyngeal residue, all of which increase the risk of penetration and aspiration (Cvejic et al, 2011; Park et al, 2010). Reduced laryngopharyngeal sensitivity has been shown in people with COPD (Clayton et al, 2014)
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