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Mancopes R, Steele CM. Videofluoroscopic measures of swallowing in people with stable COPD compared to healthy aging. Codas 2023; 36:e20220260. [PMID: 37878956 PMCID: PMC10727231 DOI: 10.1590/2317-1782/20232022260] [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: 11/11/2022] [Accepted: 02/17/2023] [Indexed: 10/27/2023] Open
Abstract
PURPOSE Swallowing impairment is a serious extra-pulmonary manifestation of Chronic Obstructive Pulmonary Disease (COPD). Previous studies suggest that individuals with stable COPD show atypical values for several videofluoroscopy measures of swallowing, compared to healthy adults under age 60. However, it is unclear to what degree these changes are attributable to healthy aging. In this study, we aimed to clarify how swallowing in people with stable COPD differs from age-matched healthy controls. METHODS We performed a retrospective analysis of videofluoroscopy data from two previously-collected datasets: a) a sample of 28 adults with stable COPD (18 male); b) a sample of 76 healthy adults, from which 28 adults were selected, matched for sex and age to participants in the COPD cohort. In both prior studies, participants swallowed 20% w/v liquid barium prepared in different consistencies (thin; mildly, moderately, and extremely thick). Blinded duplicate ratings were performed according to a standard procedure, yielding measures of laryngeal vestibule closure (LVC) integrity and timing, swallow timing, upper esophageal sphincter (UES) opening, pharyngeal constriction and pharyngeal residue. Mann-Whitney U tests and odds ratios were performed to determine significant group differences (p<.05). RESULTS Across the consistencies tested, participants with COPD showed significantly shorter durations of LVC, earlier onsets and shorter durations of UES opening, and reduced pharyngeal constriction. No significant differences were seen in other measures. CONCLUSION These results point to features of swallowing in people with stable COPD that differ from changes seen with healthy aging, and which represent risks for potential aspiration.
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Affiliation(s)
- Renata Mancopes
- Swallowing Rehabilitation Research Laboratory, KITE Research Institute - Toronto Rehabilitation Institute, University Health Network - Toronto (ON), Canada.
| | - Catriona Margaret Steele
- Swallowing Rehabilitation Research Laboratory, KITE Research Institute - Toronto Rehabilitation Institute, University Health Network - Toronto (ON), Canada.
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto - Toronto (ON), Canada.
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2
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Rockenbach NDM, Pasqualoto AS, Busanello-Stella AR. Influence of handgrip strength on pharyngeal transit time in individuals with chronic obstructive pulmonary disease. Braz J Otorhinolaryngol 2022; 89:222-229. [PMID: 36127269 PMCID: PMC10071532 DOI: 10.1016/j.bjorl.2022.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 02/25/2022] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To investigate the relationship between Handgrip Strength (HGS), dysphagia classification, nutritional aspects, and Pharyngeal Transit Time (PTT) in subjects with Chronic Obstructive Pulmonary Disease (COPD). METHODS Study based on the analysis of secondary data from a database. The sample comprised 15 COPD patients of both sexes and a mean age of 65.7 years. We collected information on HGS, videofluoroscopic swallowing study, Volume-Viscosity Swallow Test (V-VST), and Body Mass Index (BMI). We applied correlation, effect size, and logistic regression tests at the 5% significance level. RESULTS Most individuals had severe COPD (66.7%), mean dominant HGS of 28.2, and non-dominant HGS of 25.3. Five subjects were malnourished, five were well-nourished, and five were obese. Most of them had normal swallowing (40%), normal V-VST results (60%), and PTT of 0.89 s (liquid) and 0.81 s (pudding-thick). There was no significant correlation between the swallowing classification and the other variables. We obtained a significant correlation (p = 0.015), though weak (r = -0.611), between non-dominant HGS and PTT. Regarding the binary logistic regression, HGS variables and HGS asymmetry were not enough to be considered a risk to clinically abnormal swallowing (V-VST). CONCLUSION Subjects with COPD in this study had a longer PTT than reported in the literature for normal subjects and a weak correlation between PTT and non-dominant HGS. The variables related to muscle condition were not considered predictors for abnormal swallowing. LEVEL OF EVIDENCE: 3
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3
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Drulia T, Hodge A. Clinical Practice Patterns of Speech-Language Pathologists Delivering Dysphagia Services to Persons with COPD: Analysis of Survey Outcomes. Semin Speech Lang 2021; 42:363-383. [PMID: 34729725 DOI: 10.1055/s-0041-1735846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Swallowing impairments co-occur with chronic obstructive pulmonary disease (COPD) leading to aspiration, disease exacerbations, and malnutrition. This pilot survey study aimed to identify current clinical practice patterns for swallowing evaluation and treatment in persons with COPD. A 35-question Qualtrics survey was deployed to medical speech-language pathology (SLP) social media sites and professional boards; flyers were distributed at a professional conference. Forty-eight SLPs completed the study. SLPs routinely include a clinical swallow examination (96%), videofluoroscopic swallowing study (79%), adjunctive respiratory measures (respiratory rate [83%], and pulse oximetry [67%], respiratory-swallow pattern [77%]) but less frequently include fiberoptic endoscopic evaluation of swallowing (23%). Self-reported advanced clinical experience and expert respiratory analysis skills were associated with adjunctive respiratory measure (respiratory rate, pulse oximetry) inclusion during assessment. Compensatory strategy training (77%) is a preferred treatment for dysphagia in COPD; however, respiratory-swallow pattern training and expiratory muscle strength training are increasing in use. SLPs self-report a comprehensive, individualized patient-centered care approach with inclusion of adjunctive respiratory-focused methods in dysphagia evaluation and treatment practice in persons with COPD. Advances in the identification of the integral role of respiratory function in swallowing integrity may be translating to clinical practice methods for dysphagia management in persons with COPD.
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Affiliation(s)
- Teresa Drulia
- Davies School of Communication Sciences and Disorders, Texas Christian University, Harris College of Nursing and Health Sciences, Fort Worth, Texas
| | - Alexis Hodge
- Davies School of Communication Sciences and Disorders, Texas Christian University, Harris College of Nursing and Health Sciences, Fort Worth, Texas.,Department of Communication Sciences and Disorders, University of Wisconsin-Madison, Madison, Wisconsin
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4
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Drulia TC, Kamarunas E, O'Donoghue C, Ludlow CL. An Exploration of Lung Volume Effects on Swallowing in Chronic Obstructive Pulmonary Disease. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:2155-2168. [PMID: 34411488 DOI: 10.1044/2021_ajslp-20-00389] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Purpose Chronic obstructive pulmonary disease (COPD) limits respiration, which may negatively impact airway safety during swallowing. It is unknown how differences in lung volume in COPD may alter swallowing physiology. This exploratory study aimed to determine how changes in lung volume impact swallow duration and coordination in persons with stable state COPD compared with older healthy volunteers (OHVs). Method Volunteers ≥ 45 years with COPD (VwCOPDs; n = 9) and OHVs (n = 10) were prospectively recruited. Group and within-participant differences were examined when swallowing at different respiratory volumes: resting expiratory level (REL), tidal volume (TV), and total lung capacity (TLC). Participants swallowed self-administered 20-ml water boluses by medicine cup. Noncued (NC) water swallows were followed by randomly ordered block swallowing trials at three lung volumes. Estimated lung volume (ELV) and respiratory-swallow patterning were quantified using spirometry and respiratory inductive plethysmography. Manometry measured pharyngeal swallow duration from onset of base of tongue pressure increase to offset of negative pressure in the pharyngoesophageal segment. Results During NC swallows, the VwCOPDs swallowed at lower lung volumes than OHVs (p = .011) and VwCOPDs tended to inspire after swallows more often than OHVs. Pharyngeal swallow duration did not differ between groups; however, swallow duration significantly decreased as the ELV increased in VwCOPDs (p = .003). During ELV manipulation, the COPD group inspired after swallowing more frequently at REL than at TLC (p = .001) and at TV (p = .002). In conclusion, increasing respiratory lung volume in COPD should improve safety by reducing the frequency of inspiration after a swallow.
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Affiliation(s)
- Teresa C Drulia
- Department of Communication Sciences and Disorders, James Madison University, Harrisonburg, VA
- Davies School of Communication Sciences and Disorders, Texas Christian University, Fort Worth
| | - Erin Kamarunas
- Department of Communication Sciences and Disorders, James Madison University, Harrisonburg, VA
| | - Cynthia O'Donoghue
- Department of Communication Sciences and Disorders, James Madison University, Harrisonburg, VA
| | - Christy L Ludlow
- Department of Communication Sciences and Disorders, James Madison University, Harrisonburg, VA
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5
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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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Steidl EMDS, Gonçalves BFDT, Rockenbach NDM, Pasqualoto AS, Mancopes R. Outcomes of manual therapy on the biomechanics of swallowing in individuals with COPD. Codas 2021; 33:e20200203. [PMID: 34320141 DOI: 10.1590/2317-1782/20192020203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 08/20/2020] [Indexed: 11/22/2022] Open
Abstract
PURPOSE Several swallowing disorders have been reported in chronic obstructive pulmonary disease (COPD) patients due to the mechanical disadvantage of the respiratory muscles caused by hyperinflation. To date, no reports have been found in the literature among the therapeutic strategies on the use of manual therapy (MT) to manage swallowing disorders in COPD. The aim of the study was to verify the outcomes of a TM program on the biomechanics of swallowing of individuals with COPD. METHODS 18 individuals with a mean age of 66.06 ± 8.86 years, 61.1% (11) men, and a FEV1% mean of 40.28 ± 16.73 were evaluated before and after TM. The measures analyzed were: oral transit time, pharyngeal transit time (PTT), number of swallows, vallecular (VL) residue and pyriform sinuses, penetration/aspiration and hyolaryngeal excursion in liquid and pasty consistencies. RESULTS A significant difference was found in PTT (p=0.04), VL residue (p=0.03), maximal hyoid elevation (p=0.003), and displacement of hyoid (p=0.02) in the pasty consistency. In the liquid consistency, we found a decrease in VL residue (p=0.001). CONCLUSION The MT program influenced the swallowing biomechanics of COPD patients demonstrated by a reduction in PTT and VL residue and increased hyoid elevation and displacement in the pasty consistency. In the liquid consistency, a decrease in VL residue was found.
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Affiliation(s)
| | | | | | | | - Renata Mancopes
- Universidade Federal de Santa Maria - UFSM - Santa Maria (RS), Brasil
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7
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Cvejic L, Guiney N, Nicholson T, Lau KK, Finlay P, Hamza K, Osadnik C, Leong P, MacDonald M, King PT, Bardin PG. Aspiration and severe exacerbations in COPD: a prospective study. ERJ Open Res 2021; 7:00735-2020. [PMID: 33532466 PMCID: PMC7836559 DOI: 10.1183/23120541.00735-2020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 10/19/2020] [Indexed: 12/14/2022] Open
Abstract
Rationale Swallow may be compromised in COPD leading to aspiration and adverse respiratory consequences. However, prevalence and consequences of detectable aspiration in stable COPD are not known. Objectives We tested the hypothesis that a significant number of patients with stable COPD will have detectable aspiration during swallow (prandial aspiration) and that they would experience more frequent severe acute exacerbations of COPD (AECOPD) over the subsequent 12 months. Methods Patients (n=151) with verified and stable COPD of all severities were recruited at a tertiary care hospital. Videofluoroscopy was conducted to evaluate aspiration using Rosenbek's scale for penetration–aspiration during 100-mL cup drinking. AECOPD was documented as moderate (antibiotics and/or corticosteroid treatment) or severe (emergency department admission or hospitalisation) over the ensuing 12 months. Measurements and main results Aspiration was observed in 30 out of 151 patients (19.9%, 18 males, 12 females; mean age 72.4 years). Patients with aspiration had more overall AECOPD events (3.03 versus 2 per patient; p=0.022) and severe AECOPD episodes (0.87 versus 0.39; p=0.032). Severe AECOPD occurred in more patients with aspiration (50% of patients versus 18.2%; OR 4.5, CI 1.9–10.5; p=0.001) and with silent aspiration (36.7% versus 18.2%; OR 2.6, CI 1.1–6.2; p=0.045). Aspiration was related to a shorter exacerbation-free period during the 12-month follow-up period (p=0.038). Conclusions Prandial aspiration is detectable in a subset of patients with COPD and was predictive of subsequent severe AECOPD. Studies to examine if the association is causal are essential to direct strategies aimed at prevention of aspiration and AECOPD. This study demonstrates that prandial aspiration occurs in ∼20% of patients with stable COPD and portends severe COPD exacerbations over the next 12 monthshttps://bit.ly/2Tx5btj
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Affiliation(s)
- Lydia Cvejic
- Monash Lung and Sleep, Monash Health, Melbourne, Australia.,School of Clinical Sciences, Monash University, Melbourne, Australia.,Hudson Institute and Monash University, Melbourne, Australia
| | - Nadine Guiney
- Monash Lung and Sleep, Monash Health, Melbourne, Australia
| | | | - Kenneth K Lau
- School of Clinical Sciences, Monash University, Melbourne, Australia.,Diagnostic Imaging, Monash Health, Melbourne, Australia
| | - Paul Finlay
- Monash Lung and Sleep, Monash Health, Melbourne, Australia
| | - Kais Hamza
- School of Mathematical Sciences, Monash University, Melbourne, Australia
| | - Christian Osadnik
- Monash Lung and Sleep, Monash Health, Melbourne, Australia.,Hudson Institute and Monash University, Melbourne, Australia
| | - Paul Leong
- Monash Lung and Sleep, Monash Health, Melbourne, Australia.,School of Clinical Sciences, Monash University, Melbourne, Australia.,Hudson Institute and Monash University, Melbourne, Australia
| | - Martin MacDonald
- Monash Lung and Sleep, Monash Health, Melbourne, Australia.,School of Clinical Sciences, Monash University, Melbourne, Australia.,Hudson Institute and Monash University, Melbourne, Australia
| | - Paul T King
- Monash Lung and Sleep, Monash Health, Melbourne, Australia.,School of Clinical Sciences, Monash University, Melbourne, Australia.,Hudson Institute and Monash University, Melbourne, Australia
| | - Philip G Bardin
- Monash Lung and Sleep, Monash Health, Melbourne, Australia.,School of Clinical Sciences, Monash University, Melbourne, Australia.,Hudson Institute and Monash University, Melbourne, Australia
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8
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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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9
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Cvejic L, Bardin PG. Swallow and Aspiration in Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med 2019; 198:1122-1129. [PMID: 29939762 DOI: 10.1164/rccm.201804-0704pp] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Lydia Cvejic
- Monash Lung & Sleep, Monash Hospital and University and Hudson Institute, Melbourne, Victoria, Australia
| | - Philip G Bardin
- Monash Lung & Sleep, Monash Hospital and University and Hudson Institute, Melbourne, Victoria, Australia
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10
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Regueiro MRB, Parreira LC, Nascimento WV, Dantas RO. Influence of Body Height on Oral and Pharyngeal Transit Time of a Liquid Bolus in Healthy Volunteers. Gastroenterology Res 2018; 11:411-415. [PMID: 30627264 PMCID: PMC6306106 DOI: 10.14740/gr1063w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 07/26/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Swallowing duration may be influenced by several factors. The effect of body height on oral-pharyngeal bolus transit has not been clearly elucidated. The hypothesis of this investigation was that height has influence on oral-pharyngeal transit time of a liquid bolus. METHODS Videofluoroscopic assessment of swallowing was performed on 40 healthy volunteers: 20 "tall" (171 cm to 207 cm) and 20 "short" (152 cm to 170 cm) subjects, 10 men and 10 women in each group. Each subject performed three swallows of 10 mL of liquid barium bolus. The following parameters were measured: oral transit time (OTT): time from the beginning of tongue tip movement at incisors to arrival of the bolus tail at the fauces; pharyngeal transit time (PTT): time between the arrival of the bolus tail at fauces and complete passage of the bolus tail through the upper esophageal sphincter (UES); pharyngeal clearance (PC): time between the arrival of the bolus head at fauces to complete passage of the bolus tail through the UES; UES opening (UESO): time between the arrival of the bolus head at the UES to complete passage of the bolus tail through the UES; duration of hyoid movement (HM): time interval between the onset and the end of hyoid movement; oral-pharyngeal transit time (OPTT): time from the beginning of tongue tip movement at incisors until complete passage of the bolus tail through the UES. The statistical analysis was done by a linear model with mixed effects. Correlation between height and swallowing events duration was assessed by Spearman's correlation coefficient (r). RESULTS In women OTT, PC, HM and OPTT were longer in tall than in short subjects, what was not seen in men. In women there was a positive correlation between OTT, PTT and OPTT and height. Men (mean height: 177 cm) had longer PTT and PC than women (mean height: 166 cm). CONCLUSIONS In women, oral and pharyngeal transit time of a 10 mL liquid bolus were influenced by height and was longer in taller subjects.
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Affiliation(s)
- Marcia R.K. Bernardi Regueiro
- Department of Ophthalmology, Otorhinolaryngology, Head and Neck Surgery, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto SP, Brazil
| | - Luana Casari Parreira
- Department of Ophthalmology, Otorhinolaryngology, Head and Neck Surgery, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto SP, Brazil
| | - Weslania Viviane Nascimento
- Gastrointestinal Physiology Laboratory, Department of Surgery, Hospital of Mataro, Universitat Autonoma de Barcelona, Spain
| | - Roberto Oliveira Dantas
- Department of Ophthalmology, Otorhinolaryngology, Head and Neck Surgery, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto SP, Brazil
- Department of Medicine, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto SP, Brazil
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11
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Gonzalez Lindh M, Blom Johansson M, Jennische M, Koyi H. Prevalence of swallowing dysfunction screened in Swedish cohort of COPD patients. Int J Chron Obstruct Pulmon Dis 2017; 12:331-337. [PMID: 28176891 PMCID: PMC5261551 DOI: 10.2147/copd.s120207] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background COPD is a common problem associated with morbidity and mortality. COPD may also affect the dynamics and coordination of functions such as swallowing. A misdirected swallow may, in turn, result in the bolus entering the airway. A growing body of evidence suggests that a subgroup of people with COPD is prone to oropharyngeal dysphagia. The aim of this study was to evaluate swallowing dysfunction in patients with stable COPD and to determine the relation between signs and symptoms of swallowing dysfunction and lung function (forced expiratory volume in 1 second percent predicted). Methods Fifty-one patients with COPD in a stable phase participated in a questionnaire survey, swallowing tests, and spirometry. A post-bronchodilator ratio of the forced expiratory volume in 1 second/best of forced vital capacity and vital capacity <0.7 was used to define COPD. Swallowing function was assessed by a questionnaire and two swallowing tests (water and cookie swallow tests). Results Sixty-five percent of the patients reported subjective signs and symptoms of swallowing dysfunction in the questionnaire and 49% showed measurable ones in the swallowing tests. For the combined subjective and objective findings, 78% had a coexisting swallowing dysfunction. No significant difference was found between male and female patients. Conclusion Swallowing function is affected in COPD patients with moderate to severe airflow limitation, and the signs and symptoms of this swallowing dysfunction were subjective, objective, or both.
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Affiliation(s)
- Margareta Gonzalez Lindh
- Department of Neuroscience, Speech and Language Pathology, Uppsala University, Uppsala, Sweden; Centre for Research and Development (CFUG), Uppsala University, County Council of Gävleborg, Gävle, Sweden
| | - Monica Blom Johansson
- Department of Neuroscience, Speech and Language Pathology, Uppsala University, Uppsala, Sweden
| | - Margareta Jennische
- Department of Neuroscience, Speech and Language Pathology, Uppsala University, Uppsala, Sweden
| | - Hirsh Koyi
- Centre for Research and Development (CFUG), Uppsala University, County Council of Gävleborg, Gävle, Sweden; Department of Respiratory Medicine, Gävle Hospital, Gävle, Sweden
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12
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Ghannouchi I, Speyer R, Doma K, Cordier R, Verin E. Swallowing function and chronic respiratory diseases: Systematic review. Respir Med 2016; 117:54-64. [PMID: 27492514 DOI: 10.1016/j.rmed.2016.05.024] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 05/16/2016] [Accepted: 05/22/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND The precise coordination between breathing and swallowing is an important mechanism to prevent pulmonary aspiration. Factors that alter breathing patterns and ventilation, such as chronic respiratory diseases, may influence that precise coordination of breathing and swallowing. PURPOSE The purpose of this systematic literature review is to examine the effects of chronic respiratory diseases on swallowing function. METHOD Literature searches were performed using the electronic databases PubMed and Embase. All articles meeting the eligibility criteria up to March 2016 were included. RESULTS All articles included studied Chronic Obstructive Pulmonary Diseases (COPD) or Obstructive Sleep Apnea (OSA); no studies involving other respiratory diseases were found. A total of 1069 abstracts were retrieved, of which twenty-six studies met the inclusion criteria; eleven studies dealt with OSA and fifteen studies dealt with COPD. CONCLUSION The outcome data indicate that chronic respiratory diseases increase the prevalence of oropharyngeal dysphagia (OD) in patients. However, the relative small number of studies, differences in selection criteria, definitions and assessment techniques used for diagnosing OSA, COPD, and OD point to the need for further research.
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Affiliation(s)
- Ines Ghannouchi
- Department of Physiology and Functional Exploration, Farhat HACHED University Hospital of Sousse, Tunisia; EA 3880 (Research Group on Ventilator Handicap), Rouen University, France.
| | - Renée Speyer
- Speech Pathology, College of Healthcare Sciences, James Cook University, Townsville, Queensland, Australia; Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Kenji Doma
- Clinical Exercise Physiology and Sport and Exercise Science, College of Healthcare Sciences, James Cook University, Townsville, Queensland, Australia
| | - Reinie Cordier
- School of Occupational Therapy and Social Work, Curtin University, Perth, Australia
| | - Eric Verin
- EA 3880 (Research Group on Ventilator Handicap), Rouen University, France; Rouen University Hospital, Pole 3R Rehabilitation Department, Rouen University, France
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13
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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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14
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Cassiani RA, Santos CM, Baddini-Martinez J, Dantas RO. Oral and pharyngeal bolus transit in patients with chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis 2015; 10:489-96. [PMID: 25784795 PMCID: PMC4356708 DOI: 10.2147/copd.s74945] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Patients with respiratory diseases, such as chronic obstructive pulmonary disease (COPD), may have swallowing dysfunction. OBJECTIVE The aim of this investigation was to evaluate the oral and pharyngeal phases of swallowing in patients with COPD. METHODS We studied 16 patients with clinical manifestations and pulmonary function tests diagnosis of COPD (mean age: 68 years) and 15 nonsmoking healthy volunteers (mean age: 65 years) with normal pulmonary function tests. All subjects were submitted to clinical and videofluoroscopic evaluation of swallowing. Each subject performed in duplicate swallows of 5 mL and 10 mL of liquid bolus, paste bolus, and a solid bolus. RESULTS In general, the duration of the events of the pharyngeal phase of swallowing was longer in COPD patients than controls. The difference was significant in the laryngeal vestibular closure, hyoid movement, and pharyngeal transit with swallows of both volumes of liquid bolus; in oral-pharyngeal transit with 5 mL paste bolus; and in pharyngeal and oral-pharyngeal transit with solid bolus. The difference between the duration of maximal laryngeal elevation and the duration of pharyngeal transit was higher in control subjects than in patients with COPD. CONCLUSION The results suggested that patients with COPD have a longer pharyngeal swallowing phase than normal subjects, which is associated with a decrease in the difference between the duration of maximal laryngeal elevation and the duration of pharyngeal transit.
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Affiliation(s)
- Rachel Aguiar Cassiani
- Department of Medicine, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Carla Manfredi Santos
- Department of Medicine, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - José Baddini-Martinez
- Department of Medicine, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Roberto Oliveira Dantas
- Department of Medicine, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
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15
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Jin J, Liu X, Sun Y. The prevalence of increased serum IgE and Aspergillus sensitization in patients with COPD and their association with symptoms and lung function. Respir Res 2014; 15:130. [PMID: 25359094 PMCID: PMC4216660 DOI: 10.1186/s12931-014-0130-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Accepted: 10/14/2014] [Indexed: 01/12/2023] Open
Abstract
Background Allergy and Aspergillus hypersensitivity (AH) were shown to be associated with severe symptoms or worse lung function in COPD patients. The prevalence of elevated total IgE (T-IgE) and its association with clinical symptoms and lung function in COPD have not been studied. The prevalence of AH and its correlation with clinical characteristics in a COPD cohort of larger sample size is also lacking. Methods 273 patients with COPD were evaluated by respiratory symptoms, blood test, chest HRCT, lung function, serum detection of T-IgE and Aspergillus specific IgE. Patients with T-IgE ≥ 1000 KU/L were further investigated for allergic bronchopulmonary aspergillosis (ABPA). Results The prevalence of elevated T-IgE and AH in patients with COPD was 47.3% and 15.0%, respectively. Eight patients (2.9%) met the diagnostic criteria for ABPA. Compared with the normal T-IgE group, patients with elevated T-IgE had a longer history of dyspnea (p < 0.01), an earlier onset of dyspnea after chronic cough/expectoration (p < 0.01), and were more likely to wheeze (p < 0.01). They also showed worse lung functions and more severe GOLD staging (p < 0.01). Analysis of the clinical data in male patients with smoking as the risk factor showed the same results. To evaluate the clinical characteristics of COPD with AH, patients with elevated T-IgE were further divided into subgroups with and without AH. When compared with the normal T-IgE group, both the two subgroups showed longer history of dyspnea (p < 0.01), an earlier onset of dyspnea (p < 0.01) and a worse status of lung function (p < 0.05). Correlation analysis demonstrated that T-IgE was correlated positively with the time length of dyspnea (r = 0.401, p < 0.001), and the ratio of duration of dyspnea to that of chronic cough/expectoration (r = 0.59, p < 0.001), but negatively with FEV1/FVC% (r = −0.194, p = 0.001), and FEV1%predicted (r = −0.219, p < 0.001). Conclusions There was a high prevalence of elevated serum T-IgE and AH in patients with COPD. Serum T-IgE level was correlated with symptoms such as dyspnea and impairment of lung function. Allergens other than Aspergillus may have similar effects on disease expression or progression of COPD.
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Affiliation(s)
| | | | - Yongchang Sun
- Department of Respiratory Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
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