Respiratory Dysphagia in COPD

Respiratory Dysphagia occurs in COPD, Emphysema, Chronic Bronchitis and Asthma because there is loss of the coordination of respiration and the functional swallow. Respiratory dysfunction and swallowing dysfunction have been noted in a wide variety of research and clinical settings, but what is less known is the close relationship of dysphagia and respiratory dysfunction with hospitalization, particularly in the elderly. As many as half to 2/3 of patients with pneumonia, for any reason whether it be acute or chronic, have swallowing difficulties. A major independent risk factor for repeat hospitalization due to pneumonia is dysphagia; dysphagia is noted in approximately 1/3 of patient hospital readmissions not associated with aspiration pneumonia but upwards of 80% of patients readmitted to the hospital with aspiration pneumonia. Dysphagia is strongly associated with the pathogenesis of pneumonia in the elderly (Cabre et al., 2013).

Complications due to Respiratory Dysphagia in these populations can cause malnutrition, dehydration, aspiration, pneumonia, decreased quality of life and mortality. Penetration of the laryngeal vestibule and aspiration of a bolus are common in patients with COPD, because COPD patients have noted delayed closure of the laryngeal vestibule, resulting in respiratory dysfunction and decreased patient safety during eating. COPD patients may breathe at points during the respiration cycle that increase the likelihood of aspiration and complications due to COPD may result in increased residue in the oral, pharyngeal and laryngeal cavities. Reduced laryngeal elevation after a COPD patient has attempted to swallow, along with cricopharyngeal dysfunction, increased needs for swallowing compensatory maneuvers and an increased duration of pharyngeal transit, which may be related to insufficient glottal pressure because patients have reduced expiratory flow. Not surprisingly, COPD patients are noted to have reduced volumes of meal consumption and dysphagia, here, likely contributes to the significant weight loss observed in patients with COPD and its related diseases (Almirall et al., 2012; Almirall et al., 2016a; Almirall et al., 2016b; Cassani et al., 2015; Steidl et al., 2014; Scelza et al., 2015).