D1.8 Speech pathologist/therapist

Speech pathologists are involved in the assessment and management of dysphagia (difficulty swallowing) in individuals with COPD and can be accessed in the community or in a hospital setting (inpatient or outpatient). Early identification of dysphagia in those with COPD and adequate management can minimise COPD exacerbations and hospital admissions (Kobayashi 2007, Schermer 2006).

The prevalence of dysphagia in patients with COPD has been reported between 17% depending on the method of assessment and disease severity (Ghannouchi 2016, Gonzalez Lindh 2017, Kertscher 2015).

Dysphagia in COPD is thought to be due to the disrupted coordination of the exhale-swallow-exhale respiratory cycle during swallowing (Gross 2009).  This incoordination may place individuals with COPD at a higher risk of aspiration, which may in turn contribute to COPD exacerbations (Gross 2009, Terada 2010) [evidence level III-2].

Further research characterising dysphagia in COPD has identified additional impairments in swallow physiology including reduced tongue control, delayed pharyngeal swallow, reduced tongue base retraction, impaired hyolaryngeal excursion, cricopharyngeal dysfunction, impaired laryngopharyngeal sensitivity and slower bolus transit (Regan 2017).

Speech Pathologists use case history from patients and their partners or carers, clinical swallow examinations, patient self-report scales and instrumental swallowing assessments – videofluoroscopy and fiberoptic endoscopic evaluation of swallowing (FEES) to assess and diagnose dysphagia (Ghannouchi 2016, Regan 2017).

Management of dysphagia in individuals with COPD is dependent on the individual’s swallowing difficulties and is prescribed by the Speech Pathologist (McKinstry 2010).