Chronic Obstructive Pulmonary Disease (COPD) and Swallowing: Current Trends in Speech-Language Pathology Clinical Practice Patterns

Abstract

Chronic Obstructive Pulmonary Disease (COPD) is a progressive respiratory disease that limits a person's ability to perform everyday activities, leads to frequent disease exacerbations requiring hospitalizations, and reduces overall quality of life. COPD may co-occur with dysphagia (swallowing impairment) due to a discoordination between the respiratory and swallowing systems that can lead to aspiration and an increased risk of pneumonia. There is currently no optimal care plan for managing dysphagia in persons who have a primary diagnosis of COPD. The purpose of this study was to identify current clinical practice patterns for persons with COPD experiencing swallowing impairment. To identify different practice patterns of American Speech-Language-Hearing Association (ASHA)-certified SLPs, we deployed a 35-question Qualtrics online survey with recruitment accrual through medical SLP social media sites, ASHA Special Interest Group 13 (Dysphagia) Community forum, and flyers distributed at the Texas Speech-Language Hearing Association conference. Eighty-seven SLPs initiated the survey and 49 SLPs had a complete data set that were analyzed. An SLP's years of clinical experience was strongly associated with their inclusion of respiratory measures, such as respiratory rate monitoring and pulse oximetry, in assessment. A moderate association was found between a clinician's self-reported expertise in respiratory measure interpretation and their routine use of respiratory rate monitoring and pulse oximetry while no association was found between adjunctive respiratory measure use and the percentage of persons with COPD on their caseload. Speech-language pathologists are routinely using clinical swallowing examinations paired with instrumental assessments (VFSS or FEES) in this patient group and utilizing the findings to deliver patient-centered treatment approaches based on their presenting swallow physiology. Dysphagia intervention in persons with COPD has also evolved to include options beyond compensatory strategy swallow training; SLP's use of interventions such as respiratory muscle strength training and respiratory-swallow pattern education is emerging. Additional investigation with a larger sample is needed to clearly identify clinical practice patterns for management of dysphagia in persons with COPD.