| Abstract | Chronic Obstructive Pulmonary Disease (COPD) is a chronic, progressive respiratory disease which obstructs airflow from the lungs and impacts a person's quality of life. Dysphagia, or swallowing impairment, co-occurs in COPD although it is often undiagnosed until the later stages of the disease. Differences in swallow function presentation between the stable state and exacerbation state, when patients experience a sudden worsening in respiratory function, have not previously been examined. Exacerbations have been posited to result in swallow dysfunction, including increased risk for bolus entry into the airway (aspiration). However, the presence of swallow dysfunction, leading to reduced airway safety, in this patient group has also been posited to influence the onset of an exacerbation in persons with COPD. The aim of this study was to identify differences in swallow function, specifically laryngeal vestibule closure reaction time (LVCRT), laryngeal vestibule closure duration (LVCD), pharyngeal duration and frequency rates of penetration and aspiration, in persons with Chronic Obstructive Pulmonary Disease (COPD) in the exacerbated state compared to the stable state. Five hundred thirty-four medical records of patients with COPD were screened in a clinical database resulting in inclusion of 49 COPD patient records in the study. Persons diagnosed with a COPD exacerbation within the 4-week period prior to the Videofluoroscopic Swallow Study (VFSS) referral were assigned to the exacerbated state group (n=24, age 62-88 years). Persons with COPD without a diagnosis of exacerbation in the previous two months were assigned to the stable state group (n=25, age 62-99 years). The clinical VFSS recordings included oral consumption of varying textures of solids and liquids mixed with radiographic barium solution (E-Z Paque 96% w/w or 60% w/v) to aid in bolus visualization as the bolus passes through the oral cavity and pharynx during the swallow. Mann-Whitney U tests revealed that pharyngeal duration, a measure of how long the bolus takes to move through the pharynx, was significantly longer in the exacerbated group compared to the stable group of persons with COPD, p=.02 However, laryngeal vestibule closure reaction time (p=.08) and laryngeal vestibule closure duration (p=.12) were not statistically different between the two COPD groups. A condensed 4 categorical level scoring method (Steele & Grace-Martin, 2017) was used, based on the eight-point Penetration-Aspiration Scale (PAS) (Rosenbek et al., 1996), to determine aspiration and penetration frequency that occurred in both the stable and exacerbated groups. Airway invasion of bolus occurred most commonly on thin and mildly thick liquid bolus trials compared to solid texture trials. The occurrence of penetration, deemed less severe than aspiration, was similar in frequency in stable COPD compared with the exacerbated group. However, more severe aspiration occurred slightly more often in the exacerbated group. The findings in this retrospective analysis support the presence of penetration and aspiration in both the stable and exacerbated COPD groups. Future prospective studies should examine differences in exacerbated and stable COPD groups compared to older healthy persons to gain understanding of the mechanisms contributing to the frequent penetration and aspiration observed in this study. |
