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      Subjective swallowing symptoms and related risk factors in COPD

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          Abstract

          Objectives

          This study aimed to investigate the prevalence of subjective ( i.e. self-reported) swallowing symptoms in a large cohort of patients with stable chronic obstructive pulmonary disease (COPD) and to identify potential related risk factors.

          Methods

          A total of 571 patients with COPD, investigated in a stable phase, participated in this multicentre study (335 females, 236 males; mean age: 68.6 years ( sd 7.7)). Data were derived from spirometry, a questionnaire and a 30-metre walking test.

          Results

          In total, 33% (n=186) patients reported at least some degree of swallowing problem. The most frequently reported symptom was food lodging in the throat (23%). A significant relationship was found between swallowing symptoms and dyspnoea, assessed as modified Medical Research Council (mMRC) ≥2 compared with <2 (46% versus 22%; p<0.001) and health-related quality of life, assessed as the COPD Assessment Test (CAT) ≥10 (40% versus 19%; p<0.001). Swallowing problems were also related to lower physical capacity (p=0.02) but not to lung function (p>0.28).

          Conclusion

          Subjective swallowing symptoms seem to be a common problem in patients with stable COPD. This problem is seen in all stages of the disease, but is more common in symptomatic patients and in patients with lower physical capacity.

          Abstract

          Patients with #COPD can experience problems swallowing food and liquid efficiently and safely, according to new research from Margareta Gonzalez Lindh and colleagues at @UU_University http://bit.ly/2Kmxyqx

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          Most cited references27

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          Understanding the impact of symptoms on the burden of COPD

          Marc Miravitlles, Anna Ribera (2017)
          Chronic obstructive pulmonary disease (COPD) imposes a substantial burden on individuals with the disease, which can include a range of symptoms (breathlessness, cough, sputum production, wheeze, chest tightness) of varying severities. We present an overview of the biomedical literature describing reported relationships between COPD symptoms and disease burden in terms of quality of life, health status, daily activities, physical activity, sleep, comorbid anxiety, and depression, as well as risk of exacerbations and disease prognosis. In addition, the substantial variability of COPD symptoms encountered (morning, daytime, and nighttime) is addressed and their implications for disease burden considered. The findings from this narrative review, which mainly focuses on real-world and observational studies, demonstrate the impact of COPD symptoms on the burden of disease and that improved recognition and understanding of their impact is central to alleviating this burden.
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            Oropharyngeal dysphagia in older persons – from pathophysiology to adequate intervention: a review and summary of an international expert meeting

            Rainer Wirth, Rainer Dziewas, Anne Beck … (2016)
            Oropharyngeal dysphagia (OD) is a highly prevalent and growing condition in the older population. Although OD may cause very severe complications, it is often not detected, explored, and treated. Older patients are frequently unaware of their swallowing dysfunction which is one of the reasons why the consequences of OD, ie, aspiration, dehydration, and malnutrition, are regularly not attributed to dysphagia. Older patients are particularly vulnerable to dysphagia because multiple age-related changes increase the risk of dysphagia. Physicians in charge of older patients should be aware that malnutrition, dehydration, and pneumonia are frequently caused by (unrecognized) dysphagia. The diagnosis is particularly difficult in the case of silent aspiration. In addition to numerous screening tools, videofluoroscopy was the traditional gold standard of diagnosing OD. Recently, the fiberoptic endoscopic evaluation of swallowing is increasingly utilized because it has several advantages. Besides making a diagnosis, fiberoptic endoscopic evaluation of swallowing is applied to evaluate the effectiveness of therapeutic maneuvers and texture modification of food and liquids. In addition to swallowing training and nutritional interventions, newer rehabilitation approaches of stimulation techniques are showing promise and may significantly impact future treatment strategies.
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              Swallowing function after stroke: prognosis and prognostic factors at 6 months.

              D. Cameron, Kenneth G. Mann, Graeme Hankey (1999)
              Swallowing dysfunction (dysphagia) is common and disabling after acute stroke, but its impact on long-term prognosis for potential complications and the recovery from swallowing dysfunction remain uncertain. We aimed to prospectively study the prognosis of swallowing function over the first 6 months after acute stroke and to identify the important independent clinical and videofluoroscopic prognostic factors at baseline that are associated with an increased risk of swallowing dysfunction and complications. We prospectively assembled an inception cohort of 128 hospital-referred patients with acute first stroke. We assessed swallowing function clinically and videofluoroscopically, within a median of 3 and 10 days, respectively, of stroke onset, using standardized methods and diagnostic criteria. All patients were followed up prospectively for 6 months for the occurrence of death, recurrent stroke, chest infection, recovery of swallowing function, and return to normal diet. At presentation, a swallowing abnormality was detected clinically in 65 patients (51%; 95% CI, 42% to 60%) and videofluoroscopically in 82 patients (64%; 95% CI, 55% to 72%). During the subsequent 6 months, 26 patients (20%; 95% CI, 14% to 28%) suffered a chest infection. At 6 months after stroke, 97 of the 112 survivors (87%; 95% CI, 79% to 92%) had returned to their prestroke diet. Clinical evidence of a swallowing abnormality was present in 56 patients (50%; 95% CI, 40% to 60%). Videofluoroscopy was performed at 6 months in 67 patients who had a swallowing abnormality at baseline; it showed penetration of the false cords in 34 patients and aspiration in another 17. The single independent baseline predictor of chest infection during the 6-month follow-up period was a delayed or absent swallowing reflex (detected by videofluoroscopy). The single independent predictor of failure to return to normal diet was delayed oral transit (detected by videofluoroscopy). Independent predictors of the combined outcome event of swallowing impairment, chest infection, or aspiration at 6 months were videofluoroscopic evidence of delayed oral transit and penetration of contrast into the laryngeal vestibule, age >70 years, and male sex. Swallowing function should be assessed in all acute stroke patients because swallowing dysfunction is common, it persists in many patients, and complications frequently arise. The assessment of swallowing function should be both clinical and videofluoroscopic. The clinical and videofluoroscopic features at presentation that are important predictors of subsequent swallowing abnormalities and complications are videofluoroscopic evidence of delayed oral transit, a delayed or absent swallow reflex, and penetration. These findings require validation in other studies.
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                Author and article information

                Journal
                Journal ID (nlm-ta): ERJ Open Res
                Journal ID (iso-abbrev): ERJ Open Res
                Journal ID (publisher-id): ERJOR
                Journal ID (hwp): erjor
                Title: ERJ Open Research
                Publisher: European Respiratory Society
                ISSN (Electronic): 2312-0541
                Publication date Collection: July 2019
                Publication date (Electronic): 25 September 2019
                Volume: 5
                Issue: 3
                Electronic Location Identifier: 00081-2019
                Affiliations
                [1 ]Centre for Research and Development, Uppsala University/Region Gävleborg, Gävle, Sweden
                [2 ]Dept of Neuroscience, Uppsala University, Uppsala, Sweden
                [3 ]Dept of Medical Sciences, Clinical Physiology, Uppsala University, Uppsala, Sweden
                [4 ]Respir. Med. Unit, Dept Med. Solna and CMM, Karolinska Institutet and Karolinska University Hospital Solna, Solna, Sweden
                [5 ]Dept of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
                [6 ]Dept of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden
                Author notes
                Margareta Gonzalez Lindh, Centre for Research and Development, Uppsala University/Region Gävleborg, CFUG Gävle Hospital 80188, Gävle, Sweden. E-mail: margareta.gonzalez.lind@ 123456regiongavleborg.se
                Author information
                https://orcid.org/0000-0002-9526-2446
                https://orcid.org/0000-0001-5093-6980
                https://orcid.org/0000-0002-0080-5023
                Article
                Publisher ID: 00081-2019
                DOI: 10.1183/23120541.00081-2019
                PMC ID: 6759627
                SO-VID: 5bf81b8c-a8c7-46fd-9085-92e0e3f16fa3
                Copyright © Copyright ©ERS 2019
                License:

                This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0.

                History
                Date received : 29 March 2019
                Date accepted : 29 July 2019
                Funding
                Funded by: Centre for Clinical Research, Uppsala University; County Council Dalarna
                Funded by: Centre for Research & Development, Uppsala University/Region Gävleborg
                Funded by: Uppsala-Örebro Regional Research Council
                Funded by: The Swedish Heart and Lung Association
                Funded by: The Swedish Heart-Lung Foundation
                Funded by: The Uppsala County Association against Heart and Lung Diseases
                Categories
                Subject: Original Articles
                Subject: COPD
                Subject: 1

                Data availability:

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