Swallowing disorders increase risk in COPD


By Mardi Chapman

24 Sep 2018

Respiratory physicians are advised to actively look for oropharyngeal dysphagia in their patients with COPD.

Professor Eric Verin, from the Rouen University Hospital in France, told the ERS International Congress that waiting for a history of coughing after swallowing would mean missing the many patients with silent aspiration.

Aspiration was a risk factor for pneumonia and COPD exacerbations and had an associated mortality of about 54% within 12 months.

He said swallowing disorders were relatively prevalent – up to 20% in people over 50 years – and higher in people with neuromuscular disorders and respiratory diseases.

Some of the mechanisms of action included weakness in the muscles associated with swallowing including the tongue, diaphragm and abdomen, gastroesophageal reflux and a lack of coordination between swallowing and ventilation.

As well as the risk of aspiration pneumonia, patients with swallowing disorders were also at risk of nutritional complications such as dehydration and malnutrition.

Professor Verin said a clinical examination offered limited information before moving onto clinical tests such as the water swallowing test, volume viscosity swallow test (V-VST) or functional endoscopic evaluation of swallowing (FEES).

Videofluoroscopy was the gold standard test to evaluate the safety and efficacy of swallowing. Normal swallowing was fast, left no residue in the pharynx and occurred between exhalations.

Professor Verin told the limbic that managing food and oral health was a key component of managing oropharyngeal dysphagia.

The European Society for Swallowing Disorders (ESSD) has a position statement on increasing bolus viscosity as a management strategy.

“We also have to assess the weakness of the tongue and other muscles, and see if the patients require re-education of those muscles.”

He added that he thought COPD medications such corticosteroids could also impact swallowing ‘but that’s only a hypothesis. It’s very new.’

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