Chronic Obstructive Pulmonary Disease and Dysphagia: What Have We Learned So Far and What Do We Still Need to Investigate?

Mancopes, Renata; Rosa, Fernanda Borowsky da; Tomasi, Lidia Lis; Pasqualoto, Adriane Schmidt; Steele, Catriona M.

doi:10.1044/2021_persp-20-00288

Cited by 3 publications

(1 citation statement)

References 59 publications

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“…Dysphagia is an under-recognized comorbidity in COPD, and the pathophysiology of swallowing impairment in COPD is not yet well established ( 16 ) . The purpose of this study was to clarify the nature of changes in swallowing in stable COPD as compared to age-matched healthy controls.…”

Section: Discussionmentioning

confidence: 99%

Videofluoroscopic measures of swallowing in people with stable COPD compared to healthy aging

Mancopes,

Steele

2024

CoDAS

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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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Section: Discussionmentioning

confidence: 99%

Videofluoroscopic measures of swallowing in people with stable COPD compared to healthy aging

Mancopes,

Steele

2024

CoDAS

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Characterizing Physiologic Swallowing Impairment Profiles: A Large-Scale Exploratory Study of Head and Neck Cancer, Stroke, Chronic Obstructive Pulmonary Disease, Dementia, and Parkinson's Disease

Clain,

Samia,

Davidson

et al. 2024

J Speech Lang Hear Res

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Purpose: The purpose of the present study was to use a large swallowing database to explore and compare the swallow-physiology impairment profiles of five dysphagia-associated diagnoses: chronic obstructive pulmonary disease (COPD), dementia, head and neck cancer (HNC), Parkinson's disease (PD), and stroke. Method: A total of 8,190 patients across five diagnoses were extracted from a de-identified swallowing database, that is, the Modified Barium Swallow Impairment Profile Swallowing Data Registry, for the present exploratory cross-sectional analysis. To identify the impairment profiles of the five diagnoses, we fit 18 partial proportional odds models, one for each of the 17 Modified Barium Swallow Impairment Profile components and the Penetration–Aspiration Scale, with impairment score as the dependent variable and diagnoses, age, sex, and race as the independent variables with interactions between age and diagnoses and between PD and dementia (in effect creating a PD with dementia [PDwDem] group). For components with > 5% missingness, we applied inverse probability weighting to correct for bias. Results: PD and COPD did not significantly differ on 13 of the 18 outcome variables (all p s > .02). Dementia, stroke, and PDwDem all showed worse impairments than COPD or PD on five of six oral components (all p s < .007). HNC had worse impairment than all diagnoses except PDwDem for nine of 10 pharyngeal components (all p s < .006). Stroke and HNC had worse penetration/aspiration than all other diagnoses (all p s < .003). Conclusions: The present results show that there are both common and differing impairment profiles among these five diagnoses. These commonalities and differences in profiles provide a basis for the generation of hypotheses about the nature and severity of dysphagia in these populations. These results are also likely highly generalizable given the size and representativeness of the data set. Supplemental Material: https://doi.org/10.23641/asha.27478245

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A Conceptual Model of Dysphagia in Older Adults

Affoo,

Namasivayam-MacDonald

2024

OBM Geriatr

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A conceptual model was developed to create a basis for understanding the risk factors and outcomes associated with dysphagia and to hypothesize the nature of the relationship between certain factors. The conceptual model was developed by two academic speech-language pathologists with ≥10 years research and clinical experience in swallowing and dysphagia in older adults. A comprehensive review of English-language literature was conducted, and relevant, evidence-informed factors associated with dysphagia in older adults were identified. The synthesis of clinical expertise and theoretical underpinnings complemented the literature review, incorporating the socio-ecological model. Discussion and brainstorming of the identified factors and their potential and/or proven relationships with dysphagia were conducted. All the factors identified were initially organized using a thematic approach, then were further structured into overarching categories, guided by the inherent relationships between the factors. The arrangement of the conceptual model framework was undertaken once these categories had been optimized, and consensus had been achieved among the authors with support from the literature. Factors were identified to increase the risk of dysphagia, be an outcome of dysphagia, or both. The conceptual model illustrates the complex multifactorial relationship between dysphagia and individual, relationship, community, and societal factors. The proposed conceptual model improves our understanding of the risk factors and outcomes associated with dysphagia in older adults. Future work should focus on empirically testing the relationships among the factors presented, so the model can ultimately be used by members of the dysphagia community to target modifiable risk factors for dysphagia, as well as identify effective treatments that optimize overall patient well-being.

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Chronic Obstructive Pulmonary Disease and Dysphagia: What Have We Learned So Far and What Do We Still Need to Investigate?

Cited by 3 publications

References 59 publications

Videofluoroscopic measures of swallowing in people with stable COPD compared to healthy aging

Videofluoroscopic measures of swallowing in people with stable COPD compared to healthy aging

Characterizing Physiologic Swallowing Impairment Profiles: A Large-Scale Exploratory Study of Head and Neck Cancer, Stroke, Chronic Obstructive Pulmonary Disease, Dementia, and Parkinson's Disease

A Conceptual Model of Dysphagia in Older Adults

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