Aspiration of food and liquid is common in those with COPD, up to 70% of adults with COPD and dysphagia (difficulty swallowing) aspirate (Good-Fratturelli 2000). Aspiration in those with COPD is thought to be due to the disrupted coordination of the exhale-swallow-exhale respiratory cycle during swallowing, cricopharyngeal muscle dysfunction, and changes in lung volume (Gross 2009, Zheng 2016). Silent aspiration has also been reported in those with COPD, which can complicate dysphagia detection and management (Zheng 2016).
The prevalence of dysphagia in patients with COPD has been reported between 17% to 42% 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].
Dysphagia and aspiration risk can be determined by a speech pathologist with an adequate history from patients and their partners or carers, clinical swallow examination and patient self-report scales (Regan 2017). Instrumental swallowing assessments – videofluoroscopy and fibreoptic endoscopic evaluation of swallowing (FEES) can be used to confirm aspiration (Ghannouchi 2016).
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).
Management for dysphagia and aspiration will be provided on an individual basis by a speech pathologist and may involve the following (McKinstry 2010):
- Rehabilitation exercises
- Swallowing – breathing retraining (compensatory swallowing techniques)
- Texture modification of diet and fluids
- Postural strategies
- Safe swallowing strategies.