MedWire News: A subgroup of patients with chronic obstructive pulmonary disease (COPD) experience aspiration of liquid during swallowing, a study by Australian researchers has demonstrated.
They believe it is the first time this functional abnormality has been documented in COPD patients and say it may help to explain the distinctive patterns of breathing and swallowing seen in the disease.
Researchers led by Phil Bardin (Monash University and Medical Center, Melbourne, Victoria) performed a case-control study in 16 patients with COPD and 15 individuals without the respiratory disorder.
All participants underwent submandibular videofluoroscopy during swallow of graduated volumes of barium to detect penetration (ie, contrast entering the airway) and aspiration (ie, contrast passing the glottis). Respiration was monitored simultaneously to gauge synchronization, and clinical outcomes were assessed at 36 months.
Writing in Respirology, Bardin's team reports that penetration/aspiration scores (assessed using the Rosenbek scale) were 3.1 in COPD patients versus 1.6 in controls, a statistically significant difference.
Penetration/aspiration occurred almost exclusively with the 100 ml liquid swallow, they note.
Six COPD patients had a Rosenbek score ≥3, denoting penetration with or without aspiration, while four COPD patients had aspiration only (score ≥6). Just one control displayed each of these abnormalities.
Interestingly, a cough was noted during penetration/aspiration in two of six individuals with COPD. Additionally, penetration/aspiration in COPD patients was associated with significantly higher respiration rates and significantly reduced hyoid elevation, post-swallow larynx penetration, and oxygen desaturation.
With regard to long-term clinical outcomes, there were no statistically significant differences between patients with and without penetration/aspiration. However, individuals with this defect had numerically higher rates of hospitalization and death than those without it.
The researchers conclude: "Overall, our results suggested that normal protective mechanisms during swallow may be compromised in COPD and that penetration/aspiration may take place when drinking relatively large volumes of fluid."
They add: "This functional abnormality may impact respiratory health in COPD."
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