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Orr E, Perera R, Sayner A, Thompson A, Pang M, Entesari-Tatafi D, Dalgleish G, Nguyen L, Cliffe L, McDonald I, Than K, Keage M, Clapham RP. Impacts of a Dysphagia Screening Questionnaire on Speech Pathology Input Using a Transdisciplinary Approach for Patients with Chronic Obstructive Pulmonary Disease in a Pulmonary Rehabilitation Program. Dysphagia 2024:10.1007/s00455-024-10713-2. [PMID: 38951236 DOI: 10.1007/s00455-024-10713-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 04/19/2024] [Indexed: 07/03/2024]
Abstract
Patients with chronic obstructive pulmonary disease (COPD) in pulmonary rehabilitation programs (PRPs) are not routinely screened for dysphagia. An Australian regional health service audit revealed that patients with COPD are frequently referred to speech pathology during acute admissions, rather than proactively to mitigate the risk of dysphagia-related consequences. Referral patterns to speech pathology using a novel transdisciplinary approach for identifying at risk for dysphagia patients in a PRP were explored. The aim of this study was to investigate the impact of a transdisciplinary dysphagia screening questionnaire on speech pathology referrals within a cohort of patients with COPD enrolled in a PRP. This quasi-experimental study introduced a dysphagia screening questionnaire in a PRP using a transdisciplinary approach. A retrospective audit of PRP patients (n = 563) between 01/01/2014 and 31/12/2018 was conducted to identify the frequency of referrals to speech pathology for dysphagia. Data was compared to a cohort of patients (n = 50) enrolled in the PRP (from 01/02/21 to 30/11/21) after introduction of the questionnaire using Fisher's exact test. Less than 1% (n = 4/563) of PRP patients were referred to speech pathology prior to implementation of the questionnaire. Following the implementation, referrals to speech pathology significantly increased to 16% (8/50) (X2 = 7.72, P < 0.05; odds ratio = 7.89 95% CI [1.94, 32.1]). Introducing a dysphagia screening questionnaire increased referrals to speech pathology from a PRP. This study demonstrated the potential for a transdisciplinary approach in early screening for patients at risk of dysphagia for patients with COPD. Further research is encouraged to explore patient motivation towards speech pathology input with COPD-related dysphagia and clinicians' perceived self-efficacy in using the questionnaire.
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Affiliation(s)
- Ellie Orr
- Speech Pathology Department, Grampians Health-Ballarat, 1 Drummond St., Ballarat, VIC, 3350, Australia.
| | - Rishni Perera
- Speech Pathology Department, Austin Health, Studley Road, Heidelberg, Melbourne, VIC, 3084, Australia
| | - Alesha Sayner
- Primary and Community Care, Grampians Health-Ballarat, 1 Drummond St., Ballarat, VIC, 3350, Australia
- Deakin Rural Health, Warrnambool, VIC, Australia
| | - Acushla Thompson
- Speech Pathology Department, Grampians Health-Ballarat, 1 Drummond St., Ballarat, VIC, 3350, Australia
| | - Michael Pang
- Physiotherapy Department, Grampians Health-Ballarat, 1 Drummond St., Ballarat, VIC, 3350, Australia
| | - Damoon Entesari-Tatafi
- Specialist Outpatient Clinics, Grampians Health-Ballarat, 1 Drummond St., Ballarat, VIC, 3350, Australia
| | - Gerard Dalgleish
- Specialist Outpatient Clinics, Grampians Health-Ballarat, 1 Drummond St., Ballarat, VIC, 3350, Australia
| | - Lisa Nguyen
- Audiology and Speech Pathology, Melbourne University, 550 Swanston St., Melbourne, VIC, 3000, Australia
| | - Lucy Cliffe
- Audiology and Speech Pathology, Melbourne University, 550 Swanston St., Melbourne, VIC, 3000, Australia
| | - Isobel McDonald
- Audiology and Speech Pathology, Melbourne University, 550 Swanston St., Melbourne, VIC, 3000, Australia
| | - Kylie Than
- Audiology and Speech Pathology, Melbourne University, 550 Swanston St., Melbourne, VIC, 3000, Australia
| | - Megan Keage
- Audiology and Speech Pathology, Melbourne University, 550 Swanston St., Melbourne, VIC, 3000, Australia
| | - Renee P Clapham
- Speech Pathology Department, St. Vincent's Health, 41 Victory Parade, Fitzroy, VIC, 3065, Australia
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Lin TF, Shune S. The Mind-Body-Breath Link During Oral Intake in Chronic Obstructive Pulmonary Disease: A Grounded Theory Analysis. Dysphagia 2023; 38:367-378. [PMID: 35713729 DOI: 10.1007/s00455-022-10473-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 05/31/2022] [Indexed: 01/27/2023]
Abstract
Both chronic obstructive pulmonary disease (COPD) and dysphagia can be complicated by the shared physiological-psychoemotional manifestations of the conditions, such as anxiety and respiratory dysfunction. Despite their shared comorbidities, clinical research and management often focus on the isolated physiological impairments of each condition separately. Crucially, the oral intake experience of individuals with COPD-central for improved quality of life-remains underexplored. Thus, the purpose of this study was to understand the oral intake experience among individuals with COPD, including perceived barriers, behaviors, and emotions. Fourteen individuals with COPD (mean age 68.9; 7 females; 2 with diagnosed dysphagia) participated. Using grounded theory methodology, semi-structured interviews were conducted and analyzed. Four themes surfaced: (a) participants experience physiological manifestations of COPD (dyspnea, coughing) during eating/drinking; (b) emotions related to eating/drinking, such as concern, fear, anxiety, panic, and frustration stem from the physiological manifestations; (c) these emotions worsen the physiological manifestations; and (d) as a result of the physiological manifestations, they adapt eating/drinking behaviors (e.g., choose easier to eat foods, reduce intake size). The theory 'the mind-body-breath feedback and feedforward loops as a contributor to the oral intake experience in individuals with COPD' is subsequently proposed. Of clinical importance, many participants did not recognize their swallowing status as an issue. Ultimately, to promote patient-centered care, we need to view the oral intake experience for individuals with COPD through a more comprehensive lens that incorporates the interrelationships between the physiological and psychoemotional manifestations of COPD and better educate patients on COPD's impact on eating and drinking.
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Affiliation(s)
- Ting-Fen Lin
- Department of Communicative Sciences and Deaf Studies, California State University, Fresno, 93740, USA.
| | - Samantha Shune
- Communication Disorders and Sciences Program, University of Oregon, Eugene, 97403, USA
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Yoshimatsu Y, Smithard DG. A Paradigm Shift in the Diagnosis of Aspiration Pneumonia in Older Adults. J Clin Med 2022; 11:jcm11175214. [PMID: 36079144 PMCID: PMC9457444 DOI: 10.3390/jcm11175214] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 08/24/2022] [Accepted: 08/31/2022] [Indexed: 12/22/2022] Open
Abstract
In older adults, community-acquired pneumonia (CAP) is often aspiration-related. However, as aspiration pneumonia (AP) lacks clear diagnostic criteria, the reported prevalence and clinical management vary greatly. We investigated what clinical factors appeared to influence the diagnosis of AP and non-AP in a clinical setting and reconsidered a more clinically relevant approach. Medical records of patients aged ≥75 years admitted with CAP were reviewed retrospectively. A total of 803 patients (134 APs and 669 non-APs) were included. The AP group had significantly higher rates of frailty, had higher SARC-F scores, resided in institutions, had neurologic conditions, previous pneumonia diagnoses, known dysphagia, and were more likely to present with vomiting or coughing on food. Nil by mouth orders, speech therapist referrals, and broad-spectrum antibiotics were significantly more common, while computed tomography scans and blood cultures were rarely performed; alternative diagnoses, such as cancer and pulmonary embolism, were detected significantly less. AP is diagnosed more commonly in frail patients, while aspiration is the underlying aetiology in most types of pneumonia. A presumptive diagnosis of AP may deny patients necessary investigation and management. We suggest a paradigm shift in the way we approach older patients with CAP; rather than trying to differentiate AP and non-AP, it would be more clinically relevant to recognise all pneumonia as just pneumonia, and assess their swallowing functions, causative organisms, and investigate alternative diagnoses or underlying causes of dysphagia. This will enable appropriate clinical management.
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Affiliation(s)
- Yuki Yoshimatsu
- Elderly Care, Queen Elizabeth Hospital, Lewisham and Greenwich NHS Trust, London SE18 4QH, UK
- Centre for Exercise Activity and Rehabilitation, School of Human Sciences, University of Greenwich, London SE10 9LS, UK
- Correspondence:
| | - David G. Smithard
- Elderly Care, Queen Elizabeth Hospital, Lewisham and Greenwich NHS Trust, London SE18 4QH, UK
- Centre for Exercise Activity and Rehabilitation, School of Human Sciences, University of Greenwich, London SE10 9LS, UK
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4
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Yoshimatsu Y, Tobino K, Nishizawa S, Yoshimine K, Oku Y. Interferential Current Stimulation for Swallowing Disorders in Chronic Obstructive Pulmonary Disease: A Preliminary Study. Prog Rehabil Med 2022; 7:20220007. [PMID: 35274062 PMCID: PMC8850183 DOI: 10.2490/prm.20220007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 01/24/2022] [Indexed: 11/15/2022] Open
Abstract
Objectives: Swallowing function is affected in patients with chronic obstructive pulmonary disease (COPD), putting them at risk of exacerbation of COPD. We previously reported the effectiveness of the repetitive saliva swallowing test (RSST) in screening for patients at risk of COPD exacerbation. However, evidence on how to improve swallowing function in this population is extremely limited. Interferential current transcutaneous electrical sensory stimulation (IFC-TESS) stimulates the larynx and pharynx, thereby improving their sensory function. IFC-TESS is an emerging tool to enhance airway protection and increase swallowing frequency; however, its safety and efficacy in patients with COPD is unknown. Therefore, we performed a preliminary prospective study focusing on stable COPD patients. Methods: Patients with stable COPD who were hospitalized for yearly evaluation were recruited. Patients were included if their RSST was 5 or less. Nurses carried out IFC-TESS twice daily for 10 days. Swallow screening results were compared before and after the 10-day intervention. Results: Ten patients were included in the study. The IFC-TESS intervention was performed safely. Patients and nurses reported no discomfort or concerns regarding the intervention. The EAT-10 and RSST scores improved significantly after the intervention, and tongue pressure also tended to improve. Conclusions: IFC-TESS may be a promising intervention to improve swallowing in patients with COPD who are easily fatigued and struggle to perform swallowing exercises.
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Affiliation(s)
- Yuki Yoshimatsu
- Department of Respiratory Medicine, Iizuka Hospital, Iizuka, Japan
| | - Kazunori Tobino
- Department of Respiratory Medicine, Iizuka Hospital, Iizuka, Japan
| | - Saori Nishizawa
- Department of Respiratory Medicine, Iizuka Hospital, Iizuka, Japan
| | - Kohei Yoshimine
- Department of Respiratory Medicine, Iizuka Hospital, Iizuka, Japan
| | - Yoshitaka Oku
- Department of Physiology, Hyogo College of Medicine, Nishinomiya, Japan
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Gonzalez Lindh M, Janson C, Koyi H. Swallowing dysfunction in patients hospitalised due to a COPD exacerbation. ERJ Open Res 2021; 7:00515-2021. [PMID: 34708116 PMCID: PMC8542964 DOI: 10.1183/23120541.00515-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 08/19/2021] [Indexed: 11/05/2022] Open
Abstract
Swallowing dysfunction is common in COPD patients with severe exacerbations but this kind of dysfunction is potentially correctable, at least in some patients. Further interventional studies on this topic are urgently needed. https://bit.ly/3mFKNq1.
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Affiliation(s)
- Margareta Gonzalez Lindh
- Dept of Neuroscience, Uppsala University, Uppsala, Sweden.,Centre for Research and Development, Uppsala University/Region Gävleborg, Uppsala, Sweden
| | - Christer Janson
- Dept Medical Sciences, Respiratory, Allergy & Sleep Research, Uppsala University, Uppsala, Sweden
| | - Hirsch Koyi
- Centre for Research and Development, Uppsala University/Region Gävleborg, Uppsala, Sweden.,Dept of Respiratory Medicine, Karolinska Institute, Stockholm, Sweden
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Wang W, Wu W, Wang B, Gao F. Effect of houttuynia on improving lung injury in chronic obstructive pulmonary disease by regulating the TLR4 signaling pathway. Food Sci Nutr 2021; 9:3389-3396. [PMID: 34262700 PMCID: PMC8269584 DOI: 10.1002/fsn3.1922] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 07/09/2020] [Accepted: 07/14/2020] [Indexed: 12/14/2022] Open
Abstract
This study aimed to investigate the effects and mechanisms of houttuynia on lung pathological injury in rats with chronic obstructive pulmonary disease (COPD). Rats were randomly divided into the normal control, COPD model (model), low-dose treatment (low, 5 mg/kg), middle-dose treatment (middle, 10 mg/kg), and high-dose treatment (high, 25 mg/kg) groups. The COPD rat model was induced by smoking combined with intratracheal instillation of lipopolysaccharide. The treatment groups were given Houttuynia by gavage at 30 min before smoking. The IL-6, IL-1β, and TNF-α concentrations in serum and BALF were determined by ELISA. The pathological morphology was detected by HE staining. The apoptosis cell number was evaluated by TUNEL assay. Apoptotic proteins (caspase-3 and caspase-9) were measured by IHC assay in lung tissues. The relative proteins [TLR4, MyD88, and p-NF-κB(p65)] were evaluated by Western blot assay in lung tissues. Compared with the model group, the low, middle, and high groups could reduce pulmonary congestion, edema, inflammatory cell infiltration, and apoptosis cell number; downregulate the protein expression of caspase-3, caspase-9, TLR4, MyD88, and NF-κB(p65) (p < .05); and inhibit the IL-6, IL-1β, and TNF-α concentrations in serum and BALF. Houttuynia could improve the morphology and apoptosis cell number in lung tissues, thereby inhibiting the activation of the TLR4/MyD88/NF-κB(p65) signaling pathway.
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Affiliation(s)
- Wei Wang
- Department of RespiratoryWangjing HospitalChinese Academy of Traditional Chinese MedicineBeijingChina
| | - Wei Wu
- Department of RespiratoryWangjing HospitalChinese Academy of Traditional Chinese MedicineBeijingChina
| | - Bin Wang
- Department of RespiratoryWangjing HospitalChinese Academy of Traditional Chinese MedicineBeijingChina
| | - Feng Gao
- Department of RespiratoryWangjing HospitalChinese Academy of Traditional Chinese MedicineBeijingChina
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7
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Gonzalez Lindh M, Janson C, Blom Johansson M, Jonsson M, Mälberg E, Allansson E, Holm C, Jennische M, Koyi H. Swallowing dysfunction in patients hospitalised due to a COPD exacerbation. ERJ Open Res 2021; 7:00173-2021. [PMID: 34109239 PMCID: PMC8181655 DOI: 10.1183/23120541.00173-2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 03/31/2021] [Indexed: 11/16/2022] Open
Abstract
Objectives This cross-sectional study aimed to investigate the prevalence of self-reported and clinically screened swallowing dysfunction (dysphagia) in COPD patients with severe exacerbations and to identify any associated factors. Findings were then compared to a control group. Methods Participants included 30 patients hospitalised due to a COPD exacerbation. The control group consisted of 30 adults hospitalised with acute cardiac symptoms. Data were derived from spirometry, the 150 mL timed water swallow test, a cookie swallow test and a dyspnoea questionnaire (modified Medical Research Council (mMRC)). Scores from the 10-item Eating Assessment Tool (EAT-10) were calculated to assess patient perception of swallowing dysfunction. Results Self-reported swallowing dysfunction and clinical signs thereof were more common in COPD patients than in the control group (67% versus 23% and 80% versus 37%, respectively; p≤0.001). Clinical signs of swallowing dysfunction in the group with acute exacerbation of COPD were associated with self-reported swallowing dysfunction (p=0.02) and xerostomia (p=0.04). Dyspnoea (mMRC ≥2) was more common among the COPD patients (90% versus 47%, p<0.001). There was a significant negative correlation between lung function and self-reported dysphagia (r=−0.39, p=0.03), but not between lung function and clinically screened dysphagia (r=−0.23, p=0.21). Conclusion COPD patients hospitalised with an acute exacerbation experienced significantly more self-reported and clinically screened swallowing dysfunction compared to a control group of patients with cardiac symptoms. Both patient groups experienced dyspnoea, but it was twice as common in the group with acute exacerbation of COPD. Both groups also experienced xerostomia. Patients hospitalised with #AECOPD experienced significantly more self-reported and clinically screened swallowing dysfunction compared to a control grouphttps://bit.ly/32awLkx
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Affiliation(s)
- Margareta Gonzalez Lindh
- Dept of Neuroscience, Uppsala University, Uppsala, Sweden.,Centre for Research and Development, Uppsala University/Region Gävleborg, Uppsala, Sweden
| | - Christer Janson
- Dept Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | | | - Mimmi Jonsson
- Dept of Neuroscience, Uppsala University, Uppsala, Sweden
| | - Emma Mälberg
- Dept of Neuroscience, Uppsala University, Uppsala, Sweden
| | | | - Cecilia Holm
- Dept of Neuroscience, Uppsala University, Uppsala, Sweden
| | | | - Hirsch Koyi
- Centre for Research and Development, Uppsala University/Region Gävleborg, Uppsala, Sweden.,Dept of Respiratory Medicine, Karolinska Institute, Stockholm, Sweden
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8
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Tadavarthi Y, Hosseini P, Reyes SE, Focht Garand KL, Pisegna JM, Pearson WG. Pilot Study of Quantitative Methods for Differentiating Pharyngeal Swallowing Mechanics by Dysphagia Etiology. Dysphagia 2021; 36:231-241. [PMID: 32410203 PMCID: PMC7666098 DOI: 10.1007/s00455-020-10123-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 04/29/2020] [Indexed: 10/24/2022]
Abstract
Quantitative analysis of modified barium swallow (MBS) imaging is useful to determine the impact of various disease states on pharyngeal swallowing mechanics. In this retrospective proof of concept study, kinematic analysis and computational analysis of swallowing mechanics (CASM) were used to demonstrate how these methods differentiate swallowing dysfunction by dysphagia etiology. Ten subjects were randomly selected from four cohorts of dysphagic patients including COPD, head and neck cancer (HNC), motor neuron disease, and stroke. Each subject was age- and gender-matched with healthy, non-dysphagic controls. MBS videos of 5 ml thin and 5 ml thick bolus trials from each subject were used. A MATLAB tracker tool was adapted and updated to collect and compile data for each video (n = 160). For kinematic measurements, a MANOVA was performed with post-hoc analyses to determine group differences. For CASM measurements, a morphometric canonical variate analysis with post hoc analysis was performed to determine group differences. Kinematic analyses indicated statistically significant differences between HNC cohort and controls in distance measurements for hyolaryngeal approximation (p = .001), laryngeal elevation (p = 0.0001), pharyngeal shortening (p = 0.0002), and stage transition duration timing (p = 0.002). Timing differences were noted between the stroke cohort and controls for pharyngeal transit time (p = 0.007). Multivariate morphometric canonical variate analysis showed significant differences between etiology groups (p < 0.0001) with eigenvectors indicating differing patterns of swallowing mechanics. This study demonstrated that swallowing mechanics among cohorts of dysphagic patients can be differentiated using kinematics and CASM, providing different but complementary quantitative methods for investigating the impact of various disease states on swallowing function.
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Affiliation(s)
| | - Pouria Hosseini
- Medical College of Georgia (MCG), Augusta University, Augusta, Georgia
| | - Stephanie E Reyes
- College of Allied Health Sciences, Augusta University, Augusta, Georgia
- Department of Otolaryngology, MCG, Augusta University, Augusta, Georgia
| | - Kendrea L Focht Garand
- Department of Speech Pathology and Audiology, University of South Alabama, Mobile, AL, USA
| | - Jessica M Pisegna
- Department of Otolaryngology-Head & Neck Surgery, Boston University School of Medicine, Boston, MA, USA
| | - William G Pearson
- Department of Cellular Biology and Anatomy, MCG, Augusta University, Augusta, Georgia.
- Department of Otolaryngology, MCG, Augusta University, Augusta, Georgia.
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Mancopes R, Peladeau-Pigeon M, Barrett E, Guran A, Smaoui S, Pasqualoto AS, Steele CM. Quantitative Videofluoroscopic Analysis of Swallowing Physiology and Function in Individuals With Chronic Obstructive Pulmonary Disease. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2020; 63:3643-3658. [PMID: 33105085 PMCID: PMC8582841 DOI: 10.1044/2020_jslhr-20-00154] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 07/06/2020] [Accepted: 08/18/2020] [Indexed: 05/26/2023]
Abstract
Purpose Dysphagia is a serious extra pulmonary manifestation of chronic obstructive pulmonary disease (COPD). However, the nature of abnormalities in swallowing physiology in COPD has yet to be clearly established. We explored the frequency of swallowing measures outside the healthy reference range in adults with COPD. Method Participants were 28 adults aged 41-79 years (18 men, 20 women) with stable COPD. Disease severity was classified as GOLD (Global Initiative For Chronic Obstructive Lung Disease) Stages 1 (4%), 2 (25%), 3 (53%), and 4 (18%). Participants underwent a videofluoroscopy and swallowed 20% w/v thin barium in, followed by 20% w/v mildly, moderately, and extremely thick barium prepared with a xanthan gum thickener. Blinded duplicate ratings of swallowing safety, efficiency, kinematics, and timing were performed according to the ASPEKT method (Analysis of Swallowing Physiology: Events, Kinematics and Timing). Comparison data for healthy adults aged < 60 years were extracted from an existing data set. Chi-square and Fisher's exact tests compared the frequencies of measures falling < 1 SD/ > 1 SD from mean reference values (or < the first or > the third quartile for skewed parameters). Results Participants with COPD did not display greater frequencies of penetration-aspiration, but they were significantly more likely (p < .05) to display incomplete laryngeal vestibule closure (LVC), longer time-to-LVC, and shorter LVC duration. They also displayed significantly higher frequencies of short upper esophageal sphincter opening, reduced pharyngeal constriction, and pharyngeal residue. Conclusion This analysis reveals differences in swallowing physiology in patients with stable COPD characterized by impaired safety related to the mechanism, timing, and duration of LVC and by impaired swallowing efficiency with increased pharyngeal residue related to poor pharyngeal constriction.
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Affiliation(s)
- Renata Mancopes
- The KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Ontario, Canada
- Dysphagia Laboratory, Graduate Program of Human Communication Disorders, Federal University of Santa Maria, Rio Grande do Sul, Brazil
| | - Melanie Peladeau-Pigeon
- The KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Ontario, Canada
| | - Emily Barrett
- The KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Ontario, Canada
| | - Andrea Guran
- The KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Ontario, Canada
| | - Sana Smaoui
- The KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Ontario, Canada
| | - Adriane Schmidt Pasqualoto
- Dysphagia Laboratory, Graduate Program of Human Communication Disorders, Federal University of Santa Maria, Rio Grande do Sul, Brazil
| | - Catriona M. Steele
- The KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Ontario, Canada
- Dysphagia Laboratory, Graduate Program of Human Communication Disorders, Federal University of Santa Maria, Rio Grande do Sul, Brazil
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10
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Lin TF, Shune S. Chronic Obstructive Pulmonary Disease and Dysphagia: A Synergistic Review. Geriatrics (Basel) 2020; 5:geriatrics5030045. [PMID: 32847110 PMCID: PMC7554843 DOI: 10.3390/geriatrics5030045] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 08/17/2020] [Accepted: 08/22/2020] [Indexed: 01/21/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a leading global cause of death and disability. The literature has previously established clear physiological characteristics of COPD-related dysphagia (swallowing difficulties). However, COPD and dysphagia are both also intimately tied to breathing and contribute to a cascade of secondary physio-psycho-emotional sequalae, such as COPD exacerbation, anxiety, depression, increased economic burden, social isolation, and decreased quality of life. Further, the collective impact of these comorbidities may magnify disease impact, resulting in a downward spiral of well-being. Thus, the clinical relevance of COPD’s and dysphagia’s frequently occurring and overlapping sequelae cannot be overlooked, as the disease-related burden of both disorders is deeply rooted in the presence of concomitant physiological and psycho-emotional consequences. The current review explores the complex network of interactions between COPD, dysphagia, and their outcomes, framing this relationship within a mind-body-breath framework. Ultimately, we propose a model that more comprehensively captures the constellation of interrelated disease characteristics and consequences, highlighting a need for researchers and healthcare providers to consider disease impact more broadly in order to maximize treatment outcomes.
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11
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Scarpel RD, Nóbrega AC, Pinho P, de Almeida Menezes IT, Souza-Machado A. Oropharyngeal Swallowing Dynamic Findings in People with Asthma. Dysphagia 2020; 36:541-550. [PMID: 32785791 DOI: 10.1007/s00455-020-10168-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 07/28/2020] [Indexed: 11/26/2022]
Abstract
Airflow obstruction in people with asthma, similar to COPD, may interfere with swallowing, increasing the risk of food or liquid entrance into the lower airways, and favoring the uncontrolled disease. To describe the complaints and findings of the oropharyngeal swallowing mechanisms in patients with mild and severe asthma, a cross-sectional study was performed. A total of 135 participants with asthma were studied, of whom 97 had severe asthma and 38 had mild asthma. All subjects answered a questionnaire with demographic information, disease exacerbations, Asthma Control Questionnaire 6 (ACQ6-Juniper 1999), GastroEsophageal Reflux Disease Symptoms Questionnaire (GERD-SQ-Fornari et al. 2004), and Eating Assessment Tool 10 (EAT-10-Gonçalves et al., 2013). The oral and pharyngeal swallowing assessment occurred via videofluoroscopic swallowing evaluation. The age range of the participants was from 19 to 80 years, with a predominance of females (78.6%). Uncontrolled asthma was observed in 50 (52%) of the patients with severe asthma and in 11 (29%) of the patients with mild asthma (ACQ6 > 1.5). The GERD-SQ and EAT-10 scores were similar in both groups. In the bivariate analysis, the group with severe asthma presented with more changes when compared to the group with mild asthma in the following events: atypical lingual movement during the swallowing of liquid in the volumes of 5 ml (p = 0.003) and 10 ml (p = 0.001), and solid (p = 0.009); oral transit time increased in swallowing of liquid in the volumes of 5 ml (p = 0.003) and 20 ml (p = 0.026); beginning of the pharyngeal swallowing phase below the mandibular ramus (p = 0.003); pharyngeal residue (p = 0.017) of solid consistency; laryngeal penetration of 5 ml (p = 0.050) and 20 ml (p = 0.032) of liquid; increased transition time between the oral and pharyngeal swallowing phases (p = 0.035) and increased pharyngeal transit time (p = 0.045) of solid consistency. Tracheal aspiration was observed only in the group with severe asthma. After the multivariate analysis, atypical tongue movement maintained a statistically significant difference between the two groups. Oropharyngeal swallowing alternations were frequent in the studied sample and more markedly present in patients with severe asthma. Multivariate regression revealed atypical lingual movement, which was greater in patients with severe asthma. The clinical significance of these findings should be further investigated.
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Affiliation(s)
- Renata D'Arc Scarpel
- Post-Graduate Program Interactive Processes of Organs and Systems, Institute of Health Sciences, Federal University of Bahia (UFBA), Avenida Orlando Gomes, 2002, 78, Piatã, Salvador, Bahia, Zipcode 41650-010, Brazil.
| | - Ana Caline Nóbrega
- Department of Speech-Language Pathology, Federal University of Bahia (UFBA) and of the Postgraduate Program Interactive Processes of Organs and Systems, Institute of Health Sciences-UFBA, Salvador, Brazil
| | - Patrícia Pinho
- Speech-Language Pathologist of the Division of Neurology and Epidemiology, Federal University of Bahia (UFBA), Salvador, Brazil
| | | | - Adelmir Souza-Machado
- Department of Biomorphology, Professor of the Postgraduate Interactive Processes Program of Organs and Systems, Institute of Health Sciences, Federal University of Bahia (UFBA), Institute of Health Sciences - UFBA and Coordinator of the Asthma Control in Bahia Program (ProAR - UFBA), Salvador, Brazil
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Schwarz M, Ward EC, Cornwell P, Coccetti A. Dysphagia screening using an allied health assistant delegation model: service considerations for implementation. Disabil Rehabil 2020; 44:1275-1283. [PMID: 32780603 DOI: 10.1080/09638288.2020.1800109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE Three facilities, involved in introducing a model of Allied Health Assistant (AHA) delegated dysphagia screening, examined barriers and facilitators to service implementation. MATERIALS AND METHODS The 3 facilities varied in size, services and location. AHAs (n = 4) and speech-language therapists (SLTs; n = 4) directly involved in implementation at each site completed semi-structured interviews exploring the implementation experience. Analysis was guided by the Consolidated Framework for Implementation Research (CFIR). RESULTS There was differential implementation across the sites. Facilitators to implementation fell within the CFIR Innovation Characteristic domain, with the "relative advantage" of the model and "design, quality and packaging" of the training and implementation resources being key facilitators. Barriers related to the Innovation Characteristic domain, regarding the tool's "adaptability" in terms of screening tools selected and the implementation environment. Issues with the Inner Setting domain, specifically the "structural characteristics," the "compatibility" of the model and the "relative priority" of the model's implementation within other organizational priorities were also barriers. CONCLUSIONS Although the service model was perceived to have relative advantage, compatibility with local work-flow priorities and service needs must be thoroughly considered if AHA delegated dysphagia screening is to be beneficial as a service model to address increasing dysphagia referral demands.IMPLICATIONS FOR REHABILITATIONDysphagia is a disabling condition which may result in medical, social and operational complications.The demands of screening, assessing, managing and providing rehabilitation for dysphagia are increasing, therefore alternative models of service delivery including delegation are increasingly being considered and implemented.This study provides evidence regarding the context and facilitators of successful AHA dysphagia screening model implementation.This evidence contributes to a growing knowledge base of delegation practices for the management of staffing resources and building of capacity for rehabilitation service delivery.
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Affiliation(s)
- Maria Schwarz
- Speech Pathology and Audiology Department, Logan Hospital, Meadowbrook, Australia.,School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Elizabeth C Ward
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia.,Centre for Functioning and Health Research, Queensland Health, Brisbane, Australia
| | - Petrea Cornwell
- Menzies Health Institute, School of Allied Health Sciences, Griffith University, Mount Gravatt, Australia
| | - Anne Coccetti
- Speech Pathology and Audiology Department, Logan Hospital, Meadowbrook, Australia
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Yoshimatsu Y, Tobino K, Nagami S, Yagi N, Oku Y. Breathing-Swallowing Discoordination and Inefficiency of an Airway Protective Mechanism Puts Patients at Risk of COPD Exacerbation. Int J Chron Obstruct Pulmon Dis 2020; 15:1689-1696. [PMID: 32764914 PMCID: PMC7381778 DOI: 10.2147/copd.s257622] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 07/02/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction Dysphagia is a newly acknowledged multifactorial risk factor for the exacerbation of chronic obstructive pulmonary disease (COPD). Effective screening methods are awaited. We performed a prospective study to evaluate the impact of musculature and breathing-swallowing discoordination on the exacerbation of COPD with a novel swallowing monitor using a piezoelectric sensor. Patients and Methods This was the second part of a prospective study of patients with COPD from the Iizuka COPD cohort. Seventy patients with stable COPD underwent dysphagia screening, skeletal muscle mass index (SMI) and tongue pressure measurements, and swallowed 3 mL and 30 mL of water while wearing a swallowing monitor. Patients were followed for one year. Results During the follow-up period, 28 patients experienced exacerbations (E group), and 42 had none (non-E group). There was no significant difference in tongue pressure measurements between the two groups. The SMI in the E group was significantly lower than that in the non-E group. Among the swallowing monitor measurements, the 3 mL I-SW% (the percentage of swallows in which inspiration preceded the swallow [out of ten 3 mL swallows]) was significantly lower in the E group than in the non-E group. Conclusion Breathing-swallowing coordination is an independent factor related to the exacerbation of COPD. Not only the presence of discoordination but also the inability to produce an airway protection mechanism may contribute to more frequent aspiration and exacerbations.
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Affiliation(s)
- Yuki Yoshimatsu
- Department of Respiratory Medicine, Iizuka Hospital, Iizuka, Fukuoka, Japan.,Department of Physiology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Kazunori Tobino
- Department of Respiratory Medicine, Iizuka Hospital, Iizuka, Fukuoka, Japan.,Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shinsuke Nagami
- Department of Speech Language Pathology and Audiology, Faculty of Rehabilitation, Kawasaki University of Medical Welfare, Kurashiki, Okayama, Japan
| | - Naomi Yagi
- Department of Physiology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.,Department of Neurology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Department of Medical Engineering, Himeji Dokkyo University, Himeji, Hyogo, Japan
| | - Yoshitaka Oku
- Department of Physiology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
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Yoshimatsu Y, Tobino K, Sueyasu T, Nishizawa S, Ko Y, Yasuda M, Ide H, Tsuruno K, Miyajima H. Repetitive Saliva Swallowing Test Predicts COPD Exacerbation. Int J Chron Obstruct Pulmon Dis 2019; 14:2777-2785. [PMID: 31824143 PMCID: PMC6900275 DOI: 10.2147/copd.s226268] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 11/11/2019] [Indexed: 12/12/2022] Open
Abstract
Introduction Predicting phenotypes at risk of chronic obstructive pulmonary disease (COPD) exacerbation is extremely important. Dysphagia is becoming recognized as one of these phenotypes. A convenient method of screening for dysphagia and COPD exacerbation risk is desired. The repetitive saliva swallowing test (RSST) is one of the least invasive dysphagia screening methods. We previously reported the possible relation between the RSST result and COPD exacerbation in a retrospective study. Based on this, we performed a prospective study to evaluate the efficacy of RSST as a predictor of COPD exacerbation and to determine its optimal cut-off value for COPD. Methods Seventy patients with COPD were recruited. Patients underwent the following dysphagia screening tests: the 10-item Eating Assessment Tool, Frequency Scale for the Symptoms of Gastroesophageal Reflux Disease, RSST, water swallowing test, and simple swallow provocation test. After one year, they were classified into two groups according to the presence of COPD exacerbation during the follow-up period. Results Twenty-seven patients had one or more exacerbations in the past year. During the follow-up period, 28 patients had one or more exacerbations (E group), and 42 had none (non-E group). There were no significant differences between the groups except for the presence of past exacerbations and the results of the RSST, when the cut-off value was set at 2, 3, 4, or 5 swallows. The number of swallows in the RSST was significantly lower in the E group than in the Non-E group. A cut-off value of 5 was the most effective. The time to first exacerbation was significantly longer in those with an RSST value of >5. The RSST was more reliable for differentiating the E group and non-E group than the presence of exacerbation in the past year (hazard ratios: 13.78 and 2.70, respectively). Conclusion An RSST cut-off value of 5 may be a strong predictor of COPD exacerbation.
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Affiliation(s)
- Yuki Yoshimatsu
- Department of Respiratory Medicine, Iizuka Hospital, Fukuoka 820-8505, Japan
| | - Kazunori Tobino
- Department of Respiratory Medicine, Iizuka Hospital, Fukuoka 820-8505, Japan.,Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8431, Japan
| | - Takuto Sueyasu
- Department of Respiratory Medicine, Iizuka Hospital, Fukuoka 820-8505, Japan
| | - Saori Nishizawa
- Department of Respiratory Medicine, Iizuka Hospital, Fukuoka 820-8505, Japan
| | - Yuki Ko
- Department of Respiratory Medicine, Iizuka Hospital, Fukuoka 820-8505, Japan
| | - Mina Yasuda
- Department of Respiratory Medicine, Iizuka Hospital, Fukuoka 820-8505, Japan
| | - Hiromi Ide
- Department of Respiratory Medicine, Iizuka Hospital, Fukuoka 820-8505, Japan
| | - Kosuke Tsuruno
- Department of Respiratory Medicine, Iizuka Hospital, Fukuoka 820-8505, Japan
| | - Hiroyuki Miyajima
- Department of Respiratory Medicine, Iizuka Hospital, Fukuoka 820-8505, Japan
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Garand KL, Strange C, Paoletti L, Hopkins-Rossabi T, Martin-Harris B. Oropharyngeal swallow physiology and swallowing-related quality of life in underweight patients with concomitant advanced chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis 2018; 13:2663-2671. [PMID: 30214184 PMCID: PMC6122895 DOI: 10.2147/copd.s165657] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Swallowing impairment (dysphagia) has been associated with COPD and may contribute to exacerbations of this chronic and progressive disease. Further, risk of mortality increases with concomitant presence of cachexia in the COPD population. The purpose of this prospective study was to depict oropharyngeal swallowing physiology in underweight patients with stable but advanced-stage COPD. Patients and methods Ten underweight patients with stable but advanced COPD underwent a modified barium swallow study. Analysis of oropharyngeal swallowing function was completed using the standardized Modified Barium Swallow Impairment Profile and the Penetration-Aspiration Scale. Scores from the Dysphagia Handicap Index and 10-item Eating Assessment Tool were collected to assess patient perception of swallowing difficulty. Findings were compared to age- and sex-matched healthy controls. Results Significantly higher MBSImP oral total scores (P=0.007) were observed in COPD patients compared to matched controls, but no difference was observed in pharyngeal total scores (P=0.105). Patients with COPD had significantly higher maximum PAS scores compared with controls (P=0.030). There was no significant difference in EAT-10 or DHI scores between patients with COPD and controls (P=0.41 and P=0.08, respectively). Conclusion Underweight patients with severe but stable COPD present with dysphagia that may not be recognized by the patient. Further investigation is needed to elucidate the interaction between the respiratory-swallowing systems, how muscular weakness may contribute to swallowing impairment, and responsiveness to swallowing treatment.
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Affiliation(s)
- Kendrea L Garand
- Department of Speech Pathology and Audiology, College of Allied Health Professions, University of South Alabama, Mobile, AL 36688, USA,
| | - Charlie Strange
- Division of Pulmonary, Critical Care, and Sleep Medicine, College of Medicine, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Luca Paoletti
- Division of Pulmonary, Critical Care, and Sleep Medicine, College of Medicine, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Theresa Hopkins-Rossabi
- Department of Communication Sciences and Disorders, School of Communication, Northwestern University, Evanston, IL 60208, USA
| | - Bonnie Martin-Harris
- Department of Communication Sciences and Disorders, School of Communication, Northwestern University, Evanston, IL 60208, USA
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Teramoto S. A possible pathological link among swallowing dysfunction, gastro-esophageal reflex, and sleep apnea in acute exacerbation in COPD patients. Int J Chron Obstruct Pulmon Dis 2016; 11:147-50. [PMID: 26869780 PMCID: PMC4734722 DOI: 10.2147/copd.s99663] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
- Shinji Teramoto
- Department of Pulmonary Medicine, Hitachinaka Medical Education and Research Center, University of Tsukuba, Ibaraki, Japan
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Gross RD, Prigent H. Chronic Obstructive Pulmonary Disease and Occult Aspiration: A Review of the Recent Literature. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2015. [DOI: 10.1007/s40141-015-0102-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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