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Laryngeal penetration and aspiration in individuals with stable COPD.
MedLine Citation:
PMID:  21054669     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
Background and objective:  Swallowing is closely coordinated with breathing but in COPD altered synchronization may predispose patients to a breach of the upper airway protective mechanisms. However, aspiration during swallow has never been shown in COPD. We examined penetration of liquid material into the airway of patients with COPD and correlated it with breathing-swallow patterns. Methods:  A case-control study was performed. Patients with COPD (n = 16) were matched with normal control subjects (n = 15). Sub-mandibular videofluoroscopy was carried out during swallow of graduated volumes of barium to detect penetration (contrast enters the airway and may contact vocal folds) and aspiration (contrast passes glottis). Respiration was monitored simultaneously to gauge synchronization. Hospitalization and mortality were assessed after 36 months. Results:  Penetration/aspiration scores were higher in patients with COPD (3.3 ± 0.7 vs 1.6 ± 0.4 in healthy controls, P = 0.03; mean ± SE). Penetration with aspiration was observed in 4/16 patients with COPD versus 1/15 controls (P = 0.07). Penetration with or without aspiration was found in 6/16 patients (P = 0.04). Inspiration-swallow-expiration patterns were favoured in individuals with COPD (P = 0.02). Penetration/aspiration was associated with higher respiratory rates (P = 0.01), reduced hyoid elevation (P = 0.04), post-swallow larynx penetration (P = 0.05) and oxygen desaturation (P = 0.01). There was a trend for the penetration/aspiration group to have an adverse outcome. Conclusions:  Upper airway protective mechanisms may be flawed in COPD, possibly through reduced coordination of breathing with swallowing. This abnormality may contribute to COPD morbidity in a subgroup of patients.
Authors:
Lydia Cvejic; Richard Harding; Thomas Churchward; Anthony Turton; Paul Finlay; David Massey; Philip G Bardin; Paul Guy
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Respirology (Carlton, Vic.)     Volume:  16     ISSN:  1440-1843     ISO Abbreviation:  Respirology     Publication Date:  2011 Feb 
Date Detail:
Created Date:  2011-01-28     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9616368     Medline TA:  Respirology     Country:  Australia    
Other Details:
Languages:  eng     Pagination:  269-75     Citation Subset:  IM    
Copyright Information:
© 2011 The Authors. Respirology © 2011 Asian Pacific Society of Respirology.
Affiliation:
Respiratory and Sleep Medicine Physiology Diagnostic Imaging Monash Institute of Medical Research, Monash University and Medical Centre, Melbourne, Victoria, Australia.
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