Swallow and Aspiration in Chronic Obstructive Pulmonary Disease.
Am J Respir Crit Care Med. 2018 Jun 25;:
Authors: Cvejic L, Bardin PG
Swallowing is a complex biomechanical process that is synchronized with breathing to protect the airway. In chronic obstructive pulmonary disease (COPD) altered upper airway protective mechanisms coupled to ventilatory adaptations may lead to laryngeal penetration during swallow that can be followed by pulmonary aspiration. To date investigations have reported a spectrum of swallow and breathing dysfunction in COPD ranging from mild (laryngeal penetration) to severe abnormality (pulmonary aspiration). However, the prevalence of penetration and aspiration in COPD is uncertain and important aspects such as a role in recurrent lung infections and repeated exacerbations are not understood. Current evidence indicates that aspiration during swallow occurs in up to 25% of individuals with COPD. Factors putatively associated with aspiration include increased respiratory rate, reduced laryngeal elevation during swallow, post-swallow pharyngeal residue and inspiration-swallow patterns. Timely identification of individuals with COPD complicated by aspiration may be critical since measures to reduce aspiration can potentially decrease lung infections, reduce COPD exacerbations and attenuate declines in pulmonary function. In this Perspective we examine evidence in COPD for laryngeal penetration and pulmonary aspiration associated with swallow. Putative mechanisms are detailed and diagnostic and therapeutic strategies are considered. We also identify important gaps in current understanding of this field and emphasize future research priorities.
PMID: 29939762 [PubMed - as supplied by publisher]