Aspiration of food and liquid is common in COPD and may be the cause of recurrent exacerbations and complications, such as pneumonia and patchy pulmonary fibrosis. Some patients with COPD experience disrupted breathing-swallowing co-ordination and may be at risk of aspiration which may also contribute to exacerbations (Gross 2009). One hospital based case-control study performed swallowing provocation tests by instillation of distilled water into the nasopharynx. Abnormal swallow reflex was associated with more frequent exacerbations of COPD (Terada 2010) [evidence level III-2].
Diagnosis is usually easy with an adequate history from patients and their partners or carers. Dry biscuits and thin fluids cause the most difficulty. Confirmation rests with assessment by a speech therapist/ pathologist and videofluoroscopy.
Treatment involves retraining in safe swallowing techniques, which may include:
- avoiding talking when eating;
- sitting upright;
- taking small mouthfuls;
- chewing adequately;
- drinking with dry foods;
- using a straw; and
- drinking thickened fluids.