Clinical Practice Patterns of Speech-Language Pathologists Delivering Dysphagia Services to Persons with COPD: Analysis of Survey Outcomes

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.

A prospective examination of swallow and cough dysfunction after lung transplantation

“…Our RR findings are consistent with previous reports in patients with pulmonary disease, 53,54 and further align with a scoping systematic review which suggested that elevated RR is a physiologic risk factor for aspiration 55 . In a previous investigation, Scherer et al 56 measured ventilatory regulation in LT recipients during carbon dioxide rebreathing, finding that LT recipients had significantly lower maximum tidal volume and RR compared to healthy controls.…”

“…[49][50][51][52] The observation that UTC appears diminished in both these populations may support findings in animal studies where, irrespective of if cough is stimulated at the larynx or intrathoracic airway, lung-volume related and pulmonary vagal afferent feedback was associated with modulation of cough. 22 Our RR findings are consistent with previous reports in patients with pulmonary disease, 53,54 and further align with a scoping systematic review which suggested that elevated RR is a physiologic risk factor for aspiration. 55 In a previous investigation, Scherer et al 56 measured ventilatory regulation in LT recipients during carbon dioxide rebreathing, finding that LT recipients had significantly lower maximum tidal volume and RR compared to healthy controls.…”

Physicians’ Perception about the Role of Speech and Language Pathologist in Dysphagia

“…The analysis supports the theory that some of physicians surveyed thinks that SLP does not involve in multidisciplinary team regarding to dysphagia management while majority of the respondents thinks that SLP rarely involves in multidisciplinary team for dysphagia management, some of the respondents thinks that SLP plays a vital role in the management of dysphagia. The finding of the present study is similar to the findings presented by [19][20][21] with the objective to explore collaboration between speech-language pathologist and physicians who were working with patients diagnosed with dysphagia. They found that the majority of the gastroenterologists thought that SLP rarely involves in an interprofessional team while some otolaryngologist thought that SLP involves in an interprofessional team when it comes to dysphagia Similarly, In Iran, in 2019 presented finding with the objective to determine physician's perspective on a multidisciplinary approach to dysphagia management.…”

Clinical practice patterns of speech‐language pathologists for screening and identifying dysphagia

“…Barriers and a lack of understanding about tradeoffs in screening protocols may prevent clinicians from sufficiently updating their practice patterns and standards. As an example, clinicians continue to use screening tools such as pulse oximetry (Artiles et al., 2021; Drulia & Hodges, 2021) and cervical auscultation (Speyer et al., 2022) in various populations despite a lack of sufficient evidence for either (Britton et al., 2018; Lagarde et al., 2016). The lack of implementation of potentially effective dysphagia screening protocols and the continued usage of an approach without any robust evidence base emphasize the need for closer communication and collaboration between the clinical and research fields.…”