COPD

Silent aspiration in COPD might explain exacerbations


There is growing evidence to suggest that prandial aspiration plays an important role in COPD exacerbations, according to research.

According to an Australian study published in ERJ Open Research, prandial aspiration was detectable in about 20% of patients with COPD.

The study of 151 patients with all severities of COPD used videofluoroscopy to evaluate aspiration during a drinking challenge.

The study found people with aspiration were more likely to experience acute exacerbations of COPD (AECOPD) and more severe exacerbations during a 12-month follow-up than people without evidence of aspiration.

The study said up to 30% of AECOPD events have no discernible cause.

“The study findings provide affirmative data with increases in overall as well as individual severe AECOPD episodes in patients with aspiration. Importantly, there was a four-fold increase in odds ratio linking aspiration with severe episodes of AECOPD in individual patients indicating that this association was not the result of a few “super-exacerbators,” the investigators said.

“These observations provide evidence that aspiration itself, or as a marker for other predisposing factors such as older age and sarcopenia, is associated with a key adverse outcome in COPD.”

“For that reason, aspiration merits consideration in diagnostic and management approaches aiming to prevent severe AECOPD, perhaps more so in patients who have a history of frequent severe events.”

Another study from the same group, also published in ERJ Open Research, had shown that swallow patterns were altered in patients with COPD who aspirate.

Writing in a Commentary in Respirology, senior investigator on the studies Professor Philip Bardin said the potential risk of AECOPD caused by prandial aspiration has received scant attention to date yet a high index of suspicion was warranted.

“Accurate diagnosis of aspiration is essential and the importance of using methodologies that aid detection of aspiration, particularly silent and episodic aspiration events, cannot be overstated,” the Commentary said.

Professor Bardin, director of the Monash Lung and Sleep Unit, told the limbic that older patients with severe COPD were likely to be at most risk of aspiration when the coordination of breathing and swallowing was disturbed.

“Some of the more recent studies have shown there is a very strong association between this tendency to aspirate and having frequent exacerbations. So now that we understand that better, it may be possible to start developing some strategies to prevent this,” he said.

He said this might include training to swallow at a slower pace with pauses between swallows to optimise respiratory–swallow coordination.

“One way this might be solved is in pulmonary rehabilitation. Every program is slightly different and most don’t have a particular component that addresses this problem so we think that is a good place to start.

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