Respiratory and Sleep Medicine Physiology Diagnostic Imaging Monash Institute of Medical Research, Monash University and Medical Centre, Melbourne, Victoria, Australia.
Respirology. 2011 Feb;16(2):269-75. doi: 10.1111/j.1440-1843.2010.01875.x.
Swallowing is closely coordinated with breathing but in COPD altered synchronization may predispose patients to a breach of the upper airway protective mechanisms. However, aspiration during swallow has never been shown in COPD. We examined penetration of liquid material into the airway of patients with COPD and correlated it with breathing-swallow patterns.
A case-control study was performed. Patients with COPD (n = 16) were matched with normal control subjects (n = 15). Sub-mandibular videofluoroscopy was carried out during swallow of graduated volumes of barium to detect penetration (contrast enters the airway and may contact vocal folds) and aspiration (contrast passes glottis). Respiration was monitored simultaneously to gauge synchronization. Hospitalization and mortality were assessed after 36 months.
Penetration/aspiration scores were higher in patients with COPD (3.3 ± 0.7 vs 1.6 ± 0.4 in healthy controls, P = 0.03; mean ± SE). Penetration with aspiration was observed in 4/16 patients with COPD versus 1/15 controls (P = 0.07). Penetration with or without aspiration was found in 6/16 patients (P = 0.04). Inspiration-swallow-expiration patterns were favoured in individuals with COPD (P = 0.02). Penetration/aspiration was associated with higher respiratory rates (P = 0.01), reduced hyoid elevation (P = 0.04), post-swallow larynx penetration (P = 0.05) and oxygen desaturation (P = 0.01). There was a trend for the penetration/aspiration group to have an adverse outcome.
Upper airway protective mechanisms may be flawed in COPD, possibly through reduced coordination of breathing with swallowing. This abnormality may contribute to COPD morbidity in a subgroup of patients.
吞咽与呼吸密切协调，但 COPD 患者的同步可能会破坏上呼吸道的保护机制。然而，COPD 患者的吞咽过程中从未出现过误吸。我们研究了 COPD 患者吞咽时液体物质渗透到气道的情况，并将其与呼吸-吞咽模式相关联。
进行了一项病例对照研究。将 16 例 COPD 患者与 15 例正常对照患者进行匹配。在吞咽不同剂量的钡剂时进行下颌下荧光透视检查，以检测渗透（造影剂进入气道并可能接触声带）和误吸（造影剂通过声门）。同时监测呼吸以评估同步性。在 36 个月后评估住院和死亡率。
COPD 患者的渗透/误吸评分较高（3.3 ± 0.7 与健康对照组的 1.6 ± 0.4 相比，P = 0.03；均数 ± SE）。在 4/16 例 COPD 患者中观察到渗透伴误吸，而在 1/15 例对照组中观察到 1 例（P = 0.07）。在 6/16 例患者中发现了渗透伴或不伴误吸（P = 0.04）。COPD 患者更倾向于吸气-吞咽-呼气模式（P = 0.02）。渗透/误吸与更高的呼吸频率相关（P = 0.01），与杓状软骨抬高减少（P = 0.04）、吞咽后喉穿透（P = 0.05）和氧饱和度降低（P = 0.01）相关。渗透/误吸组有不良预后的趋势。
COPD 患者的上呼吸道保护机制可能存在缺陷，可能是由于呼吸与吞咽协调性降低所致。这种异常可能导致部分 COPD 患者的发病率增加。
