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COPD-related
problems hard to swallow
Newswise — Patients with moderate to severe
chronic obstructive pulmonary disease (COPD)
exhibit a disordered breathing-swallowing
pattern that may account for their higher
risk of aspiration pneumonia, according to
new research from the University of
Pittsburgh.
In the first issue for April of the American
Thoracic Society’s American Journal of
Respiratory and Critical Care Medicine,
Roxann Diez Gross, Ph.D., and colleagues
report that patients with moderate to severe
COPD exhibit alterations between breathing
and swallowing patterns even when they are
not experiencing exacerbations.
While it was previously known that COPD
patients exhibited decoupling of the
breathing-swallowing pattern of saliva
during exacerbations, until now there were
no formal studies detailing to what extent,
if any, disruptions in breathing and
swallowing coordination occurred in COPD
patients outside of exacerbations during
normal eating.
The researchers examined the relationship
between swallowing and timing of breathing
in 25 patients with moderate to severe COPD
and compared them with 25 healthy subjects.
Each subject was asked to consume nine wafer
cookies and ten teaspoons of pudding to
determine whether there were differences in
the handling of solid versus semi-solid
food.
The researchers found that in patients with
COPD, a pattern emerged that was strikingly
different from that of healthy controls.
“In healthy subjects, the usual pattern is
to time swallows to occur during early to
mid exhalation.
"Healthy
individuals also nearly exclusively follow
each swallow with exhalation.
"This pattern assures that there is
sufficient air pressure below the vocal
folds during a swallow and prevents
inhalation of food residue after
swallowing,” said Dr. Gross.
“In contrast, in COPD patients, we saw that
several aspects of their swallowing and
breathing timing were disrupted such that
swallows were occurring during inhalation or
where followed by inhalation. COPD patients
also swallowed more often at the end of
exhalation at lower lung volumes.”
The complicated physiology of the upper
respiratory tract may be thrown out of
balance by the respiratory burden imposed by
COPD, explained Dr. Gross.
“Because
breathing and eating share the structures of
the upper airway, precise coordination is
needed to prevent food material from
entering the airway while eating.
In patients with COPD, the competition for
the upper airway may cause the respiratory
drive to override swallowing function and
disrupt the normal patterning.
The lungs of COPD patients have less
elasticity than those of healthy individuals
and this may also play a role swallowing
safety.”
Difficulty swallowing is often related to
weakness and is associated with many
neurological diseases such as Parkinson’s
disease.
The observed impaired breathing and
swallowing patterns in the COPD patients
suggest a possible explanation for the
presence of swallowing disorders in persons
that do not have neurological illness.
Dr. Gross also points out the immediate
clinical implication of these findings:
“Unrecognized aspiration can occur prior to
or during COPD exacerbation and may
contribute to the onset and severity of the
exacerbations.
Patients with COPD should have their
swallowing function evaluated during
hospitalizations and aspiration should be
suspected when COPD exacerbations cannot be
linked to viral infections or other
factors,” she said.
Further research is being conducted that
examines the interactions between control of
the respiratory cycle, lung elasticity and
swallowing function. Currently, therapies
that manipulate the respiratory system are
being developed to improve swallowing
function and safety
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