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Nagoya K, Tsujimura T, Yoshihara M, Watanabe M, Magara J, Kawasaki K, Inoue M. Physiological analyses of swallowing changes due to chronic obstructive pulmonary disease in anesthetized male rats. Front Physiol 2024; 15:1445336. [PMID: 39170764 PMCID: PMC11337103 DOI: 10.3389/fphys.2024.1445336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Accepted: 07/18/2024] [Indexed: 08/23/2024] Open
Abstract
Chronic obstructive pulmonary disease (COPD) was previously known as chronic bronchitis and emphysema. It has various main symptoms, such as dyspnea, chronic cough, and sputum, and is often accompanied by dysphagia. Although many published clinical reports have described COPD-related dysphagia, the physiological mechanisms underlying swallowing changes due to COPD remain unclear. Therefore, we analyzed how COPD affects the swallowing reflex using COPD model rats. We performed an electrophysiological study of respiration and swallowing using COPD model induced by intratracheal administration of porcine pancreatic elastase and lipopolysaccharide in Sprague-Dawley male rats. To identify the respiration and swallowing responses, electromyographic activity was recorded from the diaphragm, digastric (Dig), and thyrohyoid (TH) muscles. We confirmed COPD using micro-computed tomography analysis and hematoxylin and eosin staining of the lungs. The duty cycle was defined as the ratio of the inspiration duration to the total respiratory duration. In COPD model rats, the duty cycle was significantly higher than that in control rats. The frequency of the swallowing reflex evoked by electrical stimulation of the superior laryngeal nerve during the inspiration phase was higher in COPD model rats than in control rats. Furthermore, long-term COPD altered Dig and TH muscle activity without pathological muscle change. Our results suggest that COPD increases the frequency of swallowing initiation during the inspiration phase. Furthermore, long-term COPD affects swallowing-related muscle activity without pathological muscle changes. These physiological changes may increase the risk of developing dysphagia. Further studies are necessary to clarify the mechanisms contributing to the functional changes in respiration and swallowing in COPD.
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Affiliation(s)
- Kouta Nagoya
- Division of Oral Functional Rehabilitation Medicine, Department of Oral Health Management, Showa University School of Dentistry, Tokyo, Japan
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Takanori Tsujimura
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Midori Yoshihara
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Masahiro Watanabe
- Department of Hygiene and Oral Health, Showa University School of Dentistry, Tokyo, Japan
| | - Jin Magara
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Katsushige Kawasaki
- Division of Oral Anatomy, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Makoto Inoue
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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Xiong S, Zhou Y, He W, Zhu J, He W, Ding M, Si D. Study on predictive models for swallowing risk in patients with AECOPD. BMC Pulm Med 2024; 24:95. [PMID: 38395811 PMCID: PMC10893668 DOI: 10.1186/s12890-024-02908-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 02/14/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Dysphagia is considered a complication in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). However, AECOPD may have risk factors for dysphagia. METHODS Through a cross-sectional study, which included 100 patients with AECOPD. General information, Pulmonary function, COPD assessment test (CAT) and modified Medical Research Council (mMRC) were collected by questionnaire. The questionnaires were administered by uniform-trained investigators using standard and neutral language, and swallowing risk was assessed by using a water swallow test (WST) on the day of patient admission. RESULTS Among the 100 included patients, 50(50%) were at risk of swallowing. Multivariate analysis using logistic regression analysis showed that age ≥ 74 years old, mMRC ≥ level 2, hospitalization days ≥ 7 days and the use of BIPAP assisted ventilation were important influencing factors for swallowing risk in patients with AECOPD. CONCLUSION Patients with AECOPD are at risk for dysphagia, assessing age, mMRC, hospitalization days and the use of BIPAP assisted ventilation can be used to screen for swallowing risk, thus contributing to the implementation of early prevention measures.
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Affiliation(s)
- Shuyun Xiong
- Guangdong Provincial Hospital of Chinese Medicine, 510000, Guangzhou, Guangdong, China
| | - You Zhou
- Guangdong Provincial Hospital of Chinese Medicine, 510000, Guangzhou, Guangdong, China
| | - Wenfeng He
- Guangzhou Red Cross Hospital, 510000, Guangzhou, Guangdong, China
| | - Jinling Zhu
- Guangdong Provincial Hospital of Chinese Medicine, 510000, Guangzhou, Guangdong, China
| | - Wenfang He
- Guangdong Provincial Hospital of Chinese Medicine, 510000, Guangzhou, Guangdong, China
| | - Meizhu Ding
- Guangdong Provincial Hospital of Chinese Medicine, 510000, Guangzhou, Guangdong, China
| | - Dongxu Si
- Guangdong Provincial Hospital of Chinese Medicine, 510000, Guangzhou, Guangdong, China.
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Correlation between Forced Vital Capacity and the Severity of Frailty-Induced Dysphagia. J Clin Med 2022; 11:jcm11071962. [PMID: 35407570 PMCID: PMC8999658 DOI: 10.3390/jcm11071962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 03/21/2022] [Accepted: 03/29/2022] [Indexed: 12/01/2022] Open
Abstract
Introduction: Frailty syndrome is a complex condition characterized by the gradual deterioration of an individual’s physical, mental, and social functions. Dysphagia is a dysfunction triggered by frailty. However, in patients with frailty syndrome, dysphagia is often undermined, and a proper evaluation is not performed. Therefore, we tried to identify the factors that can provide proper information regarding dysphagia in the frail population. Methods: Patients with dysphagia were divided into those with frailty-induced dysphagia and those with brain-lesion-induced dysphagia. Factors related to the participants’ pulmonary function test (PFT) results were evaluated. The severity of dysphagia was evaluated by determining modified videofluoroscopic dysphagia scale (mVDS) and penetration−aspiration scale (PAS) scores based on videofluoroscopic swallowing studies. Statistical analysis was performed to determine the correlation between PFT results and the parameters indicating dysphagia severity. Results: Multivariate logistic regression analysis revealed that forced vital capacity (FVC) was significantly correlated with mVDS scores in frailty-induced dysphagia (p < 0.05). However, no such significance was detected in brain-lesion-induced dysphagia (p ≥ 0.05). Conclusion: FVC was correlated with the severity of dysphagia (mVDS scores) in patients with frailty-induced dysphagia. Thus, serial FVC-based follow-up can be helpful for understanding patients’ dysphagia status. However, studies with a general population of patients with frailty-induced dysphagia are needed for definite generalization.
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Alani SS, Stierwalt J, LaPointe LL, Morris RJ, Jeong AC, Filson Moses J, Upton TD. An Investigation of Pulse Oximetry Levels during Swallowing in Healthy Adults and in Individuals with Severe and Very Severe Chronic Obstructive Pulmonary Disease. Semin Speech Lang 2022; 43:361-377. [PMID: 35276735 DOI: 10.1055/s-0042-1743486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
To compare pulse oximetry (PO) levels during swallowing in healthy adults and adults with severe chronic obstructive pulmonary disease (COPD). Participants included two groups of 60 healthy adults, balanced for gender. The young group ranged from 18 to 38 years, and the older group from 60 to 87 years. In addition, there were 11 participants with COPD aged 43 to 82 years. PO levels were collected as each participant swallowed 10 mL of water, 10 mL of applesauce, and a piece of diced pear (three trials each). Analyses for the healthy groups revealed neither statistically significant main effects for bolus type nor interactions between gender and age. For between-subject effects, there was no main effect for gender, but there was a large main effect for age, and a gender and age interaction. In the group with COPD, there were no significant differences across bolus types; however, PO measures were consistently lower than the healthy groups for all bolus types. Healthy adults exhibited stable PO levels across bolus types. Adults with COPD, although exhibiting significantly lower PO levels, also remained stable. For clinicians who monitor PO measures, these results offer a more comprehensive understanding of the nature of these measures during swallowing in these groups.
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Affiliation(s)
- Salim S Alani
- Department of Speech-Language Pathology, College of Health and Human Services, California State University, Long Beach, Long Beach, California
| | - Julie Stierwalt
- Division of Speech Pathology, Department of Neurology, Mayo Clinic, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Leonard L LaPointe
- School of Communication Science and Disorders, Program in Neuroscience, Florida State University, Tallahassee, Florida
| | - Richard J Morris
- School of Communication Science and Disorders, Florida State University, Tallahassee, Florida
| | - Allan C Jeong
- Department of Educational Psychology and Learning Systems, Instructional Systems and Learning Technologies Program, Florida State University, Tallahassee, Florida
| | - Jennifer Filson Moses
- Department of Psychology and Statistics, Los Angeles Pierce College, Woodland Hills, California
| | - Thomas D Upton
- Rehabilitation Education Training Program, School of Health Sciences, Applied Sciences and Arts, Southern Illinois University, Carbondale, Illinois
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Kinnear W, Dring K, Kinnear K, Hansel J, Sovani M. How to eat, drink and speak on non-invasive ventilation. Chron Respir Dis 2021; 18:14799731211061156. [PMID: 34931876 PMCID: PMC8724989 DOI: 10.1177/14799731211061156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We report our observations on six individuals with non-bulbar neuromuscular disorders using non-invasive ventilation (NIV), who were able to maintain adequate hydration and nutrition orally despite being ventilator-dependant. All had severe respiratory muscle weakness, with a vital capacity less than 500 mL and cough peak flow rate less than 250 L/min. Their median (range) age was 49 (23–64) years; they had been on NIV for 8 (2–24) years. We compared them with an age- and sex-matched normal control. Individuals with neuromuscular disorders needed to chew each mouthful of food significantly more times (median 44, range 18–120 chews) than normal controls (median 15, range 10–20 chews). They took longer to completely swallow a mouthful of food (median 37, range 24–100 s) compared to normal controls (median 14.5, range 10–21 s). Multiple swallows for each mouthful were seen in all neuromuscular individuals, but in only one normal control. Two individuals coughed after swallowing; both these subjects were clinically stable at the time of the study. The median number of NIV breaths associated with chest expansion for each mouthful was 11 (range 5–49). All subjects blocked some NIV breaths whilst eating. Before swallowing, they always waited until the expiratory phase of the NIV breath was complete; no post-swallow expiration was seen, whereas normal subjects invariably exhibited post-swallow expiration. All individuals were able to block several ventilator breaths whilst swallowing un-thickened liquids. The median (range) number of words between breaths was 5 (4–7) for the neuromuscular individuals on NIV, significantly fewer than 11 (8–13) for the matched controls. Eating, drinking and speaking are possible whilst on NIV. Use of cough-assist after eating is recommended, given the likelihood of silent aspiration.
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Affiliation(s)
- William Kinnear
- Department of Sport Science, School of Science and Technology, 6122Nottingham Trent University, Nottingham, UK
| | - Karah Dring
- Department of Sport Science, School of Science and Technology, 6122Nottingham Trent University, Nottingham, UK
| | | | - Jane Hansel
- Queens Medical Centre Campus, 9820Nottingham University Hospitals, Nottingham, UK
| | - Milind Sovani
- Queens Medical Centre Campus, 9820Nottingham University Hospitals, Nottingham, UK
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Hao N, Sasa A, Kulvanich S, Nakajima Y, Nagoya K, Magara J, Tsujimura T, Inoue M. Coordination of Respiration, Swallowing, and Chewing in Healthy Young Adults. Front Physiol 2021; 12:696071. [PMID: 34326780 PMCID: PMC8313873 DOI: 10.3389/fphys.2021.696071] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 06/15/2021] [Indexed: 11/18/2022] Open
Abstract
Examining the coordination of respiration and swallowing is important for elucidating the mechanisms underlying these functions and assessing how respiration is linked to swallowing impairment in dysphagic patients. In this study, we assessed the coordination of respiration and swallowing to clarify how voluntary swallowing is coordinated with respiration and how mastication modulates the coordination of respiration and swallowing in healthy humans. Twenty-one healthy volunteers participated in three experiments. The participants were asked to swallow 3 ml of water with or without a cue, to drink 100 ml of water using a cup without breathing between swallows, and to eat a 4-g portion of corned beef. The major coordination pattern of respiration and swallowing was expiration–swallow–expiration (EE type) while swallowing 3 ml of water either with or without a cue, swallowing 100 ml of water, and chewing. Although cueing did not affect swallowing movements, the expiratory time was lengthened with the cue. During 100-ml water swallowing, the respiratory cycle time and expiratory time immediately before swallowing were significantly shorter compared with during and after swallowing, whereas the inspiratory time did not differ throughout the recording period. During chewing, the respiratory cycle time was decreased in a time-dependent manner, probably because of metabolic demand. The coordination of the two functions is maintained not only in voluntary swallowing but also in involuntary swallowing during chewing. Understanding the mechanisms underlying respiration and swallowing is important for evaluating how coordination affects physiological swallowing in dysphagic patients.
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Affiliation(s)
- Naohito Hao
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Anna Sasa
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Sirima Kulvanich
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Yuta Nakajima
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Kouta Nagoya
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Jin Magara
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Takanori Tsujimura
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Makoto Inoue
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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