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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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Hashemi-Bajgani SM, Samareh-Fekri M, Paghaleh AJ, Yazdani R, Zarandi MA, Shafahi A. Prevalence of Micro-Aspiration of Bile Acids in Patients with Primary Lung Cancer: A Cross-Sectional Study. Ethiop J Health Sci 2022; 32:715-722. [PMID: 35950065 PMCID: PMC9341028 DOI: 10.4314/ejhs.v32i4.7] [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: 02/07/2022] [Accepted: 03/25/2022] [Indexed: 11/17/2022] Open
Abstract
Background Lung cancer remains a serious public health problem and is the first cause of cancer-related death worldwide. There is some evidence suggests that bile acid micro-aspiration may contribute to the development of lung diseases. This study aimed to assess the prevalence of micro-aspiration of bile acids in patients with primary lung cancer. Methods In a cross-sectional study, 52 patients with primary lung cancer referred to a teaching hospital affiliated with Kerman University of Medical Sciences, Kerman, Iran were enrolled. Patients with pathology-confirmed lung cancer who did not receive specific treatment were included in the present study. All patients underwent bronchoscopy and the levels of bile acid was assessed in their Broncho-Alveolar Lavage (BAL) samples. Results According to the results, 53.85% of patients were in the age group of 40 to 59 years. Of the participants, 88.46% were male, 82.69% were smokers, and 69.23% were opium addicted. The most common presenting clinical symptoms of patients were heartburn (61.55%), hoarseness (17.31%), and epigastric pain (9.61%), respectively. Ninety-two point thirty-two percent of patients had endobronchial lesions in bronchoscopy. Squamous cell carcinoma, small-cell lung carcinoma and adenocarcinoma accounts for 48.08%, 34.61% and 17.31% of all cases of lung cancer, respectively. Bile acids were found in the BAL sample of all patients with primary lung cancer. The mean Bile acids levels in patients were 63.42 (SD=7.03) µmol/Lit. Conclusion According to the results of present study, there was a micro-aspiration of bile acids in all patients with primary lung cancer that may participate in shaping early events in the etiology of primary lung cancer. It seems that developing clinical strategies preventing the micro-aspiration of bile acids into the lungs could remove a key potential trigger in this process.
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Affiliation(s)
| | - Mitra Samareh-Fekri
- Cardiovascular Research Center, Basic and Clinical Institute of Physiology, Kerman University of Medical Sciences, Kerman, Iran
| | - Arshia Jamali Paghaleh
- Afzalipour Hospital Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Rostam Yazdani
- Afzalipour Hospital Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Mahboobe Asadi Zarandi
- Afzalipour Hospital Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Ahmad Shafahi
- Afzalipour Hospital Research Center, Kerman University of Medical Sciences, Kerman, Iran
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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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Teramoto S. The current definition, epidemiology, animal models and a novel therapeutic strategy for aspiration pneumonia. Respir Investig 2021; 60:45-55. [PMID: 34782300 DOI: 10.1016/j.resinv.2021.09.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 09/16/2021] [Accepted: 09/23/2021] [Indexed: 02/02/2023]
Abstract
In the 21st century, aspiration pneumonia (ASP) is very common in older patients, and has a high mortality rate. ASP is diagnosed following confirmation of inflammatory findings in the lungs and overt aspiration or the existence of dysphagia. It is dominant in hospitalized community-acquired pneumonia (CAP), nursing and healthcare-associated pneumonia (NHCAP), and hospital-acquired pneumonia (HAP). The incidence of ASP is increasing every year. The human and experimental animal data revealed that micro-aspiration due to dysphagia during the night is the central mechanism of ASP. Therefore, the precise assessment of swallowing function is the key to diagnose ASP. From a therapeutic point of view, an appropriate administration of antibiotics, as well as a comprehensive approach for dysphagia plays a pivotal role in the prognosis and recovery from ASP. The non-pharmacologic approach, including swallowing rehabilitation and oral care, and a pharmacologic approach including ACE inhibitors and bronchodilators, are essential modalities for treatment and prevention of ASP. The clinical data of NHCAP provides us with a promising treatment strategy for ASP.
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Affiliation(s)
- Shinji Teramoto
- Department of Respiratory Medicine, Tokyo Medical University Hachioji Medical Center, Japan.
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Prestes D, Rosa FBD, Bilheri DFD, Santos TDD, Albuquerque IMD, Mancopes R, Pasqualoto AS. Relationship of pharyngeal transition time and presence of residue with dyspnea and lung function in chronic obstructive pulmonary disease. Codas 2021; 33:e20200062. [PMID: 34524362 DOI: 10.1590/2317-1782/20202020062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 12/09/2020] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To relate pharyngeal transit time and the presence of residues with dyspnea and lung function in individuals with Chronic Obstructive Pulmonary Disease COPD. METHODS Study conducted with 19 adults (11 men, 8 women) with a clinical and spirometric diagnosis of COPD and a mean age of 63.8 years (SD = 9.3). Data collection was performed using the COPD Assessment Test (CAT) questionnaire, the modified Medical Research Council scale (mMRC) and a digital manovacuometer, to characterize the impact of the disease on the individual, dyspnea and lung function. The data related to pharyngeal transit time and pharyngeal residue were collected through the analysis of videofluoroscopic images performed by three blinded judges. RESULTS No significant relationship was found between pharyngeal transit time (PTT) with lung function (r = -0.71), pharyngeal residue and dyspnea (r = -0.06). PTT, when compared to normality, was increased. CONCLUSION Individuals with COPD, regardless of the severity of the disease, showed no association between PTT and pharyngeal residue and dyspnea and lung function.
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Affiliation(s)
- Daniele Prestes
- Programa de Pós-graduação em Distúrbios da Comunicação Humana, Universidade Federal de Santa Maria - UFSM - Santa Maria (RS), Brasil
| | - Fernanda Borowsky da Rosa
- Programa de Pós-graduação em Distúrbios da Comunicação Humana, Universidade Federal de Santa Maria - UFSM - Santa Maria (RS), Brasil
| | - Diego Fernando Dorneles Bilheri
- Programa de Pós-graduação em Distúrbios da Comunicação Humana, Universidade Federal de Santa Maria - UFSM - Santa Maria (RS), Brasil
| | - Tamires Daros Dos Santos
- Programa de Pós-graduação em Distúrbios da Comunicação Humana, Universidade Federal de Santa Maria - UFSM - Santa Maria (RS), Brasil
| | - Isabella Martins de Albuquerque
- Departamento de Fisioterapia e Reabilitação, Universidade Federal de Santa Maria - UFSM - Santa Maria (RS), Brasil.,Programa de Pós-graduação em Reabilitação Funcional, Universidade Federal de Santa Maria - UFSM - Santa Maria (RS), Brasil
| | - Renata Mancopes
- Programa de Pós-graduação em Distúrbios da Comunicação Humana, Universidade Federal de Santa Maria - UFSM - Santa Maria (RS), Brasil.,The KITE Research Institute - Toronto Rehabilitation Institute, University Health Network - Toronto (Ontario), Canada
| | - Adriane Schmidt Pasqualoto
- Programa de Pós-graduação em Distúrbios da Comunicação Humana, Universidade Federal de Santa Maria - UFSM - Santa Maria (RS), Brasil.,Departamento de Fisioterapia e Reabilitação, Universidade Federal de Santa Maria - UFSM - Santa Maria (RS), Brasil
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6
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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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7
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Lee AL, Goldstein RS. Gastroesophageal reflux disease in COPD: links and risks. Int J Chron Obstruct Pulmon Dis 2015; 10:1935-49. [PMID: 26392769 PMCID: PMC4574848 DOI: 10.2147/copd.s77562] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
COPD is a long-term condition associated with considerable disability with a clinical course characterized by episodes of worsening respiratory signs and symptoms associated with exacerbations. Gastroesophageal reflux disease (GERD) is one of the most common gastrointestinal conditions in the general population and has emerged as a comorbidity of COPD. GERD may be diagnosed by both symptomatic approaches (including both typical and atypical symptoms) and objective measurements. Based on a mix of diagnostic approaches, the prevalence of GERD in COPD ranges from 17% to 78%. Although GERD is usually confined to the lower esophagus in some individuals, it may be associated with pulmonary microaspiration of gastric contents. Possible mechanisms that may contribute to GERD in COPD originate from gastroesophageal dysfunction, including altered pressure in the lower esophageal sphincter (which normally protect against GERD) and changes in esophageal motility. Proposed respiratory contributions to the development of GERD include respiratory medications that may alter esophageal sphincter tone and changes in respiratory mechanics, with increased lung hyperinflation compromising the antireflux barrier. Although the specific cause and effect relationship between GERD and COPD has not been fully elucidated, GERD may influence lung disease severity and has been identified as a significant predictor of acute exacerbations of COPD. Further clinical effects could include a poorer health-related quality of life and an increased cost in health care, although these factors require further clarification. There are both medical and surgical options available for the treatment of GERD in COPD and while extensive studies in this population have not been undertaken, this comorbidity may be amenable to treatment.
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Affiliation(s)
- Annemarie L Lee
- West Park Healthcare Centre, University of Toronto, Toronto, ON, Canada ; Department of Physical Therapy, University of Toronto, Toronto, ON, Canada ; Institute for Breathing and Sleep, Austin Hospital, Melbourne, VIC, Australia
| | - Roger S Goldstein
- West Park Healthcare Centre, University of Toronto, Toronto, ON, Canada ; Department of Physical Therapy, University of Toronto, Toronto, ON, Canada ; Department of Medicine, University of Toronto, Toronto, ON, Canada
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Pitts T, Gayagoy AG, Rose MJ, Poliacek I, Condrey JA, Musslewhite MN, Shen TY, Davenport PW, Bolser DC. Suppression of Abdominal Motor Activity during Swallowing in Cats and Humans. PLoS One 2015; 10:e0128245. [PMID: 26020240 PMCID: PMC4447283 DOI: 10.1371/journal.pone.0128245] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 04/23/2015] [Indexed: 11/18/2022] Open
Abstract
Diseases affecting pulmonary mechanics often result in changes to the coordination of swallow and breathing. We hypothesize that during times of increased intrathoracic pressure, swallow suppresses ongoing expiratory drive to ensure bolus transport through the esophagus. To this end, we sought to determine the effects of swallow on abdominal electromyographic (EMG) activity during expiratory threshold loading in anesthetized cats and in awake-healthy adult humans. Expiratory threshold loads were applied to recruit abdominal motor activity during breathing, and swallow was triggered by infusion of water into the mouth. In both anesthetized cats and humans, expiratory cycles which contained swallows had a significant reduction in abdominal EMG activity, and a greater percentage of swallows were produced during inspiration and/or respiratory phase transitions. These results suggest that: a) spinal expiratory motor pathways play an important role in the execution of swallow, and b) a more complex mechanical relationship exists between breathing and swallow than has previously been envisioned.
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Affiliation(s)
- Teresa Pitts
- Department of Neurological Surgery, Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, United States of America
- * E-mail:
| | - Albright G. Gayagoy
- Department of Physiological Sciences, University of Florida, Gainesville, FL, United States of America
| | - Melanie J. Rose
- Department of Physiological Sciences, University of Florida, Gainesville, FL, United States of America
| | - Ivan Poliacek
- Department of Physiological Sciences, University of Florida, Gainesville, FL, United States of America
| | - Jillian A. Condrey
- Department of Physiological Sciences, University of Florida, Gainesville, FL, United States of America
| | - M. Nicholas Musslewhite
- Department of Physiological Sciences, University of Florida, Gainesville, FL, United States of America
| | - Tabitha Y. Shen
- Department of Physiological Sciences, University of Florida, Gainesville, FL, United States of America
| | - Paul W. Davenport
- Department of Physiological Sciences, University of Florida, Gainesville, FL, United States of America
| | - Donald C Bolser
- Department of Physiological Sciences, University of Florida, Gainesville, FL, United States of America
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Kamble NL, Khan NA, Kumar N, Nayak HK, Daga MK. Study of gastro-oesophageal reflux disease in patients with mild-to-moderate chronic obstructive pulmonary disease in India. Respirology 2013; 18:463-7. [PMID: 23062059 DOI: 10.1111/j.1440-1843.2012.02285.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVE To study the incidence and pattern of gastro-oesophageal reflux disease (GORD) in patients with mild-to-moderate chronic obstructive pulmonary disease (COPD) using dual-probe 24-h oesophageal pH recording. METHODS This was a prospective study of 50 patients with mild-to-moderate stage COPD based on the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines. A detailed history of illness along with spirometry was done in all patients. In the study group, reflux symptoms were measured using a validated scoring system. All the patients underwent oesophageal manometry and dual-probe 24-h oesophageal pH recording. RESULTS Symptoms of gastro-oesophageal reflux were present in 38 patients. Twenty-four-hour oesophageal pH monitoring revealed pathological reflux in 31 out of 38 symptomatic and 8 out of 12 asymptomatic patients. The overall rate of GORD was 78% in our study. Only distal GORD was observed in 11 (28.9%), and both distal and proximal GORD was observed in 20 (52.6%) out of the 38 symptomatic subjects. In the remaining 12 asymptomatic patients, eight had GORD. Distal GORD was present in six (50%) patients, and two (16.6%) had both distal and proximal GORD in this group. Isolated proximal GORD was not observed in any patient. CONCLUSIONS There is an increased occurrence of GORD in patients with even mild-to-moderate COPD.
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Affiliation(s)
- Nitish L Kamble
- Department of Medicine, Maulana Azad Medical College Department of Biosciences, Jamia Millia Islamia, New Delhi, India
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van der Maarel-Wierink CD, Vanobbergen JNO, Bronkhorst EM, Schols JMGA, de Baat C. Risk factors for aspiration pneumonia in frail older people: a systematic literature review. J Am Med Dir Assoc 2011; 12:344-54. [PMID: 21450240 DOI: 10.1016/j.jamda.2010.12.099] [Citation(s) in RCA: 171] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2010] [Revised: 12/28/2010] [Accepted: 12/28/2010] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To systematically review the risks for aspiration pneumonia in frail older people and the contribution of bad oral health among the risk factors. DESIGN Systematic literature review. SETTING PubMed (Medline), Web of Science, Cochrane Library, EMBASE, and CINAHL were searched for eligible studies, published in English in the period January 2000 to April 2009. PARTICIPANTS Frail older people. MEASUREMENTS Only publications with regard to hospitalized, institutionalized, or frail home-dwelling people of 60 years and older were eligible. Two authors independently assessed the publications for their methodological quality. Unadjusted and adjusted odds ratios and their corresponding 95% confidence intervals for respective risk factors related to aspiration pneumonia were extracted. The results were evaluated according to the levels of evidence of the Oxford Centre for Evidence-based Medicine. RESULTS A total of 21 publications fulfilled the quality criteria. Evidence level 2a (systematic review with homogeneity of cohort studies) was found for a positive relationship between aspiration pneumonia and age, male gender, lung diseases, dysphagia, and diabetes mellitus; 2b (individual cohort study) for severe dementia, angiotensin I-converting enzyme deletion/deletion genotype, and bad oral health; 3a (systematic review with homogeneity of case-control studies) for malnutrition; 3b (individual case-control study) for Parkinson's disease and the use of antipsychotic drugs, proton pump inhibitors, and angiotensin-converting enzyme inhibitors. The contribution of bad oral health among the risk factors seems limited. CONCLUSION Thirteen significant risk factors were identified: age, male gender, lung diseases, dysphagia, diabetes mellitus, severe dementia, angiotensin I-converting enzyme deletion/deletion genotype, bad oral health, malnutrition, Parkinson's disease, and the use of antipsychotic drugs, proton pump inhibitors, and angiotensin-converting enzyme inhibitors. The contribution of bad oral health seems limited.
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Terada K, Muro S, Ohara T, Kudo M, Ogawa E, Hoshino Y, Hirai T, Niimi A, Chin K, Mishima M. Abnormal swallowing reflex and COPD exacerbations. Chest 2009; 137:326-32. [PMID: 19783670 DOI: 10.1378/chest.09-0482] [Citation(s) in RCA: 99] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND It is unclear whether an abnormal swallowing reflex affects COPD exacerbations. This study investigated the prevalence of abnormal swallowing reflexes and its relationship with COPD exacerbation prospectively. We also clarified its association with gastroesophageal reflux disease (GERD) and airway bacterial colonization. METHODS Swallowing reflex and serum C-reactive protein (CRP) levels were examined in subjects with stable COPD and in control subjects. Concurrently, GERD symptoms were assessed using a self-reported questionnaire, and sputum bacterial cultures were investigated in the same subjects. Exacerbations were counted prospectively during the following 12 months. RESULTS The study group comprised 67 subjects with COPD and 19 controls. The prevalence of abnormal swallowing reflex was significantly higher in subjects with COPD (22/67) than controls (1/19; P = .02). Among subjects with COPD, the serum CRP level, GERD symptoms, isolation of sputum bacteria, and the frequency of exacerbations were significantly increased in those with abnormal swallowing reflexes compared with controls (2.72 vs 1.04 mg/L, P = .04, for serum CRP level; 6.75 vs 4.10 points, P = .04, for GERD symptoms; 5/11 vs 3/22, P = .04, for the isolation of sputum bacteria; and 2.82 vs 1.56/y, P = .007, for the annual frequency of exacerbations). Multivariable analysis confirmed that abnormal swallowing reflex was significantly associated with frequent exacerbations (>or= 3/y; P = 0.01). CONCLUSIONS Abnormal swallowing reflexes frequently occurred in subjects with COPD and predisposed them to exacerbations. Abnormal swallowing reflexes in COPD might be affected by the comorbidity of GERD, and cause bacterial colonization.
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Affiliation(s)
- Kunihiko Terada
- Department of Respiratory Medicine, Kyoto University, Sakyo-ku, Kyoto, Japan
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12
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Masiero S, Pierobon R, Previato C, Gomiero E. Pneumonia in stroke patients with oropharyngeal dysphagia: a six-month follow-up study. Neurol Sci 2008; 29:139-45. [PMID: 18612760 DOI: 10.1007/s10072-008-0925-2] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2008] [Accepted: 05/21/2008] [Indexed: 01/25/2023]
Abstract
The aim of the study was to estimate the frequency of pneumonia and to determine the risk factors for this complication in poststroke patients with oropharyngeal dysphagia (OD). We prospectively followed up 67 patients (mean age 72.9+/-12.2 years) in the first 6 months after stroke, during which time we recorded gender, stroke side, type of lesion, diabetes, history of chronic obstructive pulmonary disease (COPD), smoking, level of consciousness, functional outcome, dietary history, occurrence of chest infection, and death. Degree of OD and presence/absence of reflex cough was assessed by Fiberoptic Endoscopic Evaluation of Swallowing. Sixty patients showed complete recovery of prestroke swallowing; 9 (13.4% IC 95%=5-20%) developed pneumonia, two of whom died. The first episode of pneumonia occurred in all nine patients within the first month after stroke onset. The pneumonia was associated with absence of reflex cough after swallow, COPD, and severe impairment of consciousness and poor functional outcome.
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Affiliation(s)
- Stefano Masiero
- Department of Rehabilitation, University of Padova, Padova, Italy.
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13
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Teramoto S, Yamamoto H, Yamaguchi Y, Tmoita T, Ouchi Y. Diffuse aspiration bronchiolitis due to achalasia. Chest 2004; 125:349-50; author reply 350. [PMID: 14718468 DOI: 10.1378/chest.125.1.349] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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