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Oropharyngeal swallow physiology and swallowing-related quality of life in underweight patients with concomitant advanced chronic obstructive pulmonary disease

Authors Garand KL, Strange C, Paoletti L, Hopkins-Rossabi T, Martin-Harris B

Received 15 February 2018

Accepted for publication 8 May 2018

Published 29 August 2018 Volume 2018:13 Pages 2663—2671

DOI https://doi.org/10.2147/COPD.S165657

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Charles Downs

Peer reviewer comments 2

Editor who approved publication: Dr Richard Russell


Kendrea L Garand,1 Charlie Strange,2 Luca Paoletti,2 Theresa Hopkins-Rossabi,3 Bonnie Martin-Harris3

1Department of Speech Pathology and Audiology, College of Allied Health Professions, University of South Alabama, Mobile, AL 36688, USA; 2Division of Pulmonary, Critical Care, and Sleep Medicine, College of Medicine, Medical University of South Carolina, Charleston, SC 29425, USA; 3Department of Communication Sciences and Disorders, School of Communication, Northwestern University, Evanston, IL 60208, USA

Background:
Swallowing impairment (dysphagia) has been associated with COPD and may contribute to exacerbations of this chronic and progressive disease. Further, risk of mortality increases with concomitant presence of cachexia in the COPD population. The purpose of this prospective study was to depict oropharyngeal swallowing physiology in underweight patients with stable but advanced-stage COPD.
Patients and methods: Ten underweight patients with stable but advanced COPD underwent a modified barium swallow study. Analysis of oropharyngeal swallowing function was completed using the standardized Modified Barium Swallow Impairment Profile and the Penetration–Aspiration Scale. Scores from the Dysphagia Handicap Index and 10-item Eating Assessment Tool were collected to assess patient perception of swallowing difficulty. Findings were compared to age- and sex-matched healthy controls.
Results: Significantly higher MBSImP oral total scores (P=0.007) were observed in COPD patients compared to matched controls, but no difference was observed in pharyngeal total scores (P=0.105). Patients with COPD had significantly higher maximum PAS scores compared with controls (P=0.030). There was no significant difference in EAT-10 or DHI scores between patients with COPD and controls (P=0.41 and P=0.08, respectively).
Conclusion: Underweight patients with severe but stable COPD present with dysphagia that may not be recognized by the patient. Further investigation is needed to elucidate the interaction between the respiratory–swallowing systems, how muscular weakness may contribute to swallowing impairment, and responsiveness to swallowing treatment.

Keywords: COPD, swallowing impairment, MBSImP, dysphagia, underweight

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