Chest
Volume 121, Issue 2, February 2002, Pages 361-369
Journal home page for Chest

Clinical Investigations
COPD
Oropharyngeal Deglutition in Stable COPD

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Study objectives

The aim of this study was to examine deglutition in stable patients with COPD and lung hyperinflation.

Design

Twenty consecutive, eligible COPD patients with an FEV1 ≤ 65% of predicted and a total lung capacity ≥120% of predicted were enrolled prospectively.

Intervention

Patients received a detailed videofluoroscopic evaluation of oropharyngeal swallowing and were compared to 20 age-matched and sex-matched historical control subjects.

Setting

An outpatient pulmonary clinic at a Veterans Affairs Medical Center.

Measurements and results

The mean total lung capacity, functional residual capacity, and residual volume for the patients were 128% of predicted, 168% of predicted, and 218% of predicted, respectively. The mean FEV1 was 39% of predicted. There was no evidence of tracheal aspiration in either group. The laryngeal position at rest measured relative to the cervical vertebrae was not different between groups. The maximal laryngeal elevation during swallowing was significantly lower in patients with COPD (p < 0.001). Patients with COPD exhibited more frequent use of spontaneous protective swallowing maneuvers such as longer duration of airway closure and earlier laryngeal closure relative to the cricopharyngeal opening than did control subjects (p < 0.05).

Conclusions

We conclude that hyperinflated patients with COPD have an altered swallowing physiology. We suspect that the protective alterations in swallowing physiology (swallow maneuvers) may reduce the risk of aspiration. However, these swallowing maneuvers may not be useful during an exacerbation and may require further research.

Section snippets

Materials and Methods

All patients attended the outpatient pulmonary clinic at the Veterans Administration Chicago Healthcare System-Lakeside Division between September 1998 and March 1999. Twenty patients were selected in a consecutive manner. The inclusion criteria were the following: (1) ≥55 years of age; (2) a smoking history ≥30 pack-years; and (3) a history, physical examination findings, chest radiograph findings, and pulmonary function test (PFT) results that are compatible with COPD, as defined by the

Results

There were 20 participants with COPD in this study, and 19 were men. Sixteen participants had an FEV1 < 50% of predicted. Nine participants were receiving home oxygen therapy. The demographics and PFT characteristics of these patients are shown in Table 1 . Four patients (20%) reported mild and intermittent dysphagia. None of these four patients had complained of these symptoms prior to completing the dysphagia questionnaire. For all patients, respiratory rate and pulse oximetry remained

Discussion

Our study is the first clinical study providing detailed analysis of swallowing in stable hyperinflated patients with COPD. The data demonstrate that COPD is associated with abnormal swallowing physiology. Abnormalities consisted of frequent spontaneous and protective maneuvers and decreased laryngeal elevation during swallowing. We suspect that protective swallowing maneuvers explain the absence of aspiration in this study.

There are limited data correlating COPD with aspiration. Cohello9 found

References (18)

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This research was supported by grant P01 CA 40007 from the National Cancer Institute of the National Institutes of Health.

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