Tongue strength and swallowing dynamics in chronic obstructive pulmonary disease

Abstract

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.

A Missing Voice: The Lingual Complex and Osteopathic Manual Medicine in the Context of Five Osteopathic Models

“…Lingual dysfunction may occur following a prolonged position with the patient prone, following pneumonia due to severe acute respiratory syndrome coronavirus 2 infection; lingual functional impairment can have serious consequences for the patient's health [81]. Similarly, with chronic pulmonary diseases such as chronic obstructive pulmonary disease and asthma, there are abnormal lingual movements, a functional decline in the strength and activity of the tongue, which reflects the decline in muscle strength of the limbs [82][83][84].…”

“…Emphysema, together with chronic bronchitis, is a phenotype that falls within chronic obstructive pulmonary disease (COPD) [92]. We know that COPD leads to neuromuscular non-coordination of the tongue, which is expressed as dysphagia and/or obstructive sleep apnea; the constant respiratory dysfunction with unintentional pulmonary aspirations, nocturnal hypoxia, and continuous awakenings lead to a cognitive decline with psychiatric alterations (anxiety and depression) in patients suffering from these disorders [82,93,94]. We can affirm that a function of the tongue non-optimally can push the patient toward a non-physiological psychiatric sphere, where anxiety and depression cause decreased quality of life of the person [95].…”