Oropharyngeal dysphagia: when swallowing disorders meet respiratory diseases

Vérin, Eric; Clavé, Père; Bonsignore, Maria R.; Marie, Jean; Bertolus, Chloé; Similowski, Thomas; Laveneziana, Pierantonio

doi:10.1183/13993003.02530-2016

Cited by 26 publications

(21 citation statements)

References 32 publications

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“…Oropharyngeal dysphagia affects more than 60% of elderly institutionalised patients [5], commonly associated with age-related atrophy of the tongue, geniohyoid muscle, and the pharynx [37][38][39]. We found no difference in the tongue strength between the COPD and healthy controls (mean ages 73 and 72 years for the COPD and control groups, respectively), both lower than weighted averages of older (>60 years) and young (20-39 years) controls [17].…”

Section: Swallowing Dynamics and The Inhibitory Reflexmentioning

confidence: 94%

“…Impaired swallowing (dysphagia), typically related to disruptions in breathing–swallowing coordination [ 2 ], has been documented in 20% of people with stable COPD [ 3 ], and in up to 56% of COPD exacerbations [ 4 ]. Most healthy adults swallow during expiration, and the positive intra-thoracic pressure serves as an airway protective mechanism to expel any misdirected material from the laryngeal vestibule [ 5 , 6 ]. In contrast, tachypnoeic COPD patients usually inspire during or immediately after swallowing, increasing their risk of aspiration and acute exacerbations [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

“…COPD commonly occurs in advanced age [ 4 , 8 ], but oropharyngeal muscle weakness as a mechanism for dysphagia has not been well explored. Fifteen percent of older adults (>65 years) have dysphagia [ 9 ] that is frequently attributed to oropharyngeal sarcopenia (loss of skeletal muscle mass and strength) [ 5 ]. As tongue strengthening, a treatment for oropharyngeal weakness, may prevent aspiration, the primary aim of this study was to evaluate tongue strength in COPD.…”

Section: Introductionmentioning

confidence: 99%

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Tongue strength and swallowing dynamics in chronic obstructive pulmonary disease

et al. 2021

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BackgroundSwallowing disorders occur in chronic obstructive pulmonary disease (COPD), but little is known about tongue strength and mastication. This is the first assessment in COPD of tongue strength and a test of mastication and swallowing solids (TOMASS).MethodsAnterior tongue strength measures were obtained in 18 people with COPD, aged 73±11 years (mean±sd), and 19 healthy age-matched controls, aged 72±6 years. Swallowing dynamics were assessed using an eating assessment tool (EAT-10), timed water swallow test (TWST), and TOMASS. Swallowing measures were compared to an inhibitory reflex in the inspiratory muscles to airway occlusion (IR; recorded previously in the same participants).ResultsTongue strength was similar between COPD and controls (p=0.715). Self-assessed scores of dysphagia EAT-10 were higher (p=0.024) and swallowing times were prolonged for liquids (p=0.022) and solids (p=0.003) in the COPD group. During TWST, ∼30% of COPD group showed clinical signs of airway invasion (cough and wet voice), but none in the control group. For solids, the COPD group had ∼40% greater number of chews (p=0.004), and two-fold-higher number of swallows (p=0.0496). Respiratory rate was 50% higher in COPD group than controls (p <0.001). The presence of an IR was not related to better swallowing outcomes, but signs of airway invasion were associated with a delayed IR.ConclusionDysphagia in stable COPD is not due to impaired anterior tongue strength, but rather swallowing-breathing discoordination. To address dysphagia, aspiration, and acute exacerbations in COPD, therapeutic targets to improve swallowing dynamics could be investigated further.

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Section: Swallowing Dynamics and The Inhibitory Reflexmentioning

confidence: 94%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Tongue strength and swallowing dynamics in chronic obstructive pulmonary disease

et al. 2021

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“…Oropharyngeal dysphagia is frequently present in adults with respiratory diseases, and it can cause complications such as aspiration pneumonia, weight loss and malnutrition [2]. It can also have a marked impact on individuals’ quality of life [3, 4].…”

Section: Introductionmentioning

confidence: 99%

The Diagnostic Accuracy of the Pitch Glide to Identify Aspiration in Patients with Respiratory Diseases: A Pilot Study

Mavrea¹,

Regan²

2019

Folia Phoniatr Logop

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Introduction: Initial research has been conducted to determine the diagnostic accuracy of the pitch glide during the clinical swallow evaluation to identify aspiration in adults post stroke. Findings suggest that reduced pitch glide can predict aspiration in patients with dysphagia post stroke. This study aimed to identify the diagnostic accuracy of the pitch glide in detecting aspiration, pharyngeal residue and hyolaryngeal excursion during swallowing in adults with respiratory diseases.Material & Methods: 17 adults (9 males, mean= 75.2, SD= 8.98, and 8 females, mean age=73.5, SD= 8.17) with dysphagia who had a background of respiratory diseases (Chronic Obstructive Pulmonary Disease=11; Lower Respiratory Tract Infection= 6) were consecutively recruited in an acute hospital setting. Participants completed two pitch glide tasks (/a/ and /i/) immediately before a videofluoroscopic swallowing study (VFSS). Pitch glide recordings were analysed by blinded researchers both acoustically (Praat software) to obtain maximum F0, pitch range and auditory-perceptually using a binary scale ("normal" or "abnormal"). Clinicians blinded to pitch glide ratings rated 5ml, 10ml and a sip of liquid swallows during VFSS using the Penetration-Aspiration Scale, Bolus Residue Scale and hyolaryngeal component of the MBSImP. Receiving Operator Curve, Pearson correlations and independent sample t-tests were used to address the research questions.Results: Maximum F0 of sound /a/ had high sensitivity and specificity in identifying aspiration on 10ml of liquids during VFSS. Both pitch glides (/a/ and /i/) had moderate sensitivity and specificity in predicting aspiration on a sip of liquids. However, auditory-perceptual measures of pitch glide had weak accuracy in identifying people who were aspirating during VFSS. Finally, all pitch glide measures (acoustic and auditory-perceptual) had low accuracy in predicting pharyngeal residue and hyolaryngeal excursion. Conclusion:Based on this initial pilot study, acoustic pitch glide of sound /a/ is an accurate way to predict aspiration on 10ml of liquids in patients with respiratory diseases. Based on findings from this study, both auditory-perceptual and acoustic analysis of pitch glide could not identify residue and hyolaryngeal excursion.

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“…Swallowing impairment (dysphagia) is one of the major complications of ARDS secondary to COVID-19 ( 6 ). ARDS compromises the respiratory system, which can result in incoordination of respiratory-swallowing systems ( 7 ). Oropharyngeal dysphagia, which includes food residue in the throat and aspiration into the airway, causes further deterioration of ventilatory functions ( 8 ) and is considered a major risk factor for aspiration pneumonia among frail and immunocompromised older adults ( 9 ).…”

mentioning

confidence: 99%

Speech-language pathologists´ role in the multi-disciplinary management and rehabilitation of patients with COVID-19

Mohapatra¹,

Mohan²

2020

J Rehabil Med-CC

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Respiratory and neurological complications in patients in various stages of COVID-19 emphasize the role of speech-language pathologists in the assessment and management of swallowing and communication deficits in these patients. The speechlanguage pathologist works within a multidisciplinary team to identify these deficits, and aims to improve swallowing, nutrition, hydration, speech, and quality of life in the medical settings. This paper describes the unique symptoms and complications associated with COVID-19 that require speech-language pathologist services in medical (acute care, inpatient, and outpatient rehabilitation) facilities. The speech-language pathologist is primarily responsible for dysphagia screening and diagnosis in the acute care units, dysphagia and tracheostomy management in the inpatient units, and swallowing, speech and voice rehabilitation and neuro cognitive management in the outpatient units. This paper also discusses the current therapeutic services and the precautions that speech-language pathologists must take to reduce transmission of the virus.

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Oropharyngeal dysphagia: when swallowing disorders meet respiratory diseases

Cited by 26 publications

References 32 publications

Tongue strength and swallowing dynamics in chronic obstructive pulmonary disease

Tongue strength and swallowing dynamics in chronic obstructive pulmonary disease

The Diagnostic Accuracy of the Pitch Glide to Identify Aspiration in Patients with Respiratory Diseases: A Pilot Study

Speech-language pathologists´ role in the multi-disciplinary management and rehabilitation of patients with COVID-19

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