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Nagami S, Oku Y, Yagi N, Sato S, Uozumi R, Morita S, Yamagata Y, Kayashita J, Tanimura K, Sato A, Takahashi R, Muro S. Breathing-swallowing discoordination is associated with frequent exacerbations of COPD. BMJ Open Respir Res 2017; 4:e000202. [PMID: 28883930 PMCID: PMC5531308 DOI: 10.1136/bmjresp-2017-000202] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Revised: 05/01/2017] [Accepted: 05/02/2017] [Indexed: 12/05/2022] Open
Abstract
Introduction Impaired coordination between breathing and swallowing (breathing–swallowing discoordination) may be a significant risk factor for the exacerbation of chronic obstructive pulmonary disease (COPD). We examined breathing–swallowing discoordination in patients with COPD using a non-invasive and quantitative technique and determined its association with COPD exacerbation. Methods We recruited 65 stable outpatients with COPD who were enrolled in our prospective observational cohort study and did not manifest an apparent swallowing disorder. COPD exacerbation was monitored for 1 year before and 1 year after recruitment. Swallowing during inspiration (the I-SW pattern) and swallowing immediately followed by inspiration (the SW-I pattern) were identified. Results The mean frequency of the I-SW and/or SW-I patterns (I-SW/SW-I rate) was 21.5%±25.5%. During the 2-year observation period, 48 exacerbation incidents (25 patients) were identified. The I-SW/SW-I rate was significantly associated with the frequency of exacerbation. During the year following recruitment, patients with a higher I-SW/SW-I frequency using thicker test foods exhibited a significantly higher probability of future exacerbations (p=0.002, log-rank test). Conclusions Breathing–swallowing discoordination is strongly associated with frequent exacerbations of COPD. Strategies that identify and improve breathing–swallowing coordination may be a new therapeutic treatment for patients with COPD.
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Affiliation(s)
- Shinsuke Nagami
- Department of Neurology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Department of Physiology, Hyogo College of Medicine, Nishinomiya, Japan.,Clinical Research Center for Medical Equipment Development (CRCMeD), Kyoto University Hospital, Kyoto, Japan
| | - Yoshitaka Oku
- Department of Physiology, Hyogo College of Medicine, Nishinomiya, Japan.,Department of Swallowing Physiology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Naomi Yagi
- Clinical Research Center for Medical Equipment Development (CRCMeD), Kyoto University Hospital, Kyoto, Japan.,Department of Swallowing Physiology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Susumu Sato
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Ryuji Uozumi
- Department of Biomedical Statistics and Bioinformatics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Satoshi Morita
- Department of Biomedical Statistics and Bioinformatics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yoshie Yamagata
- Department of Health Sciences, Prefectural University Hiroshima, Hiroshima, Japan
| | - Jun Kayashita
- Department of Health Sciences, Prefectural University Hiroshima, Hiroshima, Japan
| | - Kazuya Tanimura
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Department of Respiratory Medicine, Chest Disease Clinical and Research Institute, Kishiwada City Hospital, Kishiwada, Japan
| | - Atsuyasu Sato
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Ryosuke Takahashi
- Department of Neurology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shigeo Muro
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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