The KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Ontario, Canada.
Dysphagia Laboratory, Graduate Program of Human Communication Disorders, Federal University of Santa Maria, Rio Grande do Sul, Brazil.
J Speech Lang Hear Res. 2020 Nov 13;63(11):3643-3658. doi: 10.1044/2020_JSLHR-20-00154. Epub 2020 Oct 26.
Purpose Dysphagia is a serious extra pulmonary manifestation of chronic obstructive pulmonary disease (COPD). However, the nature of abnormalities in swallowing physiology in COPD has yet to be clearly established. We explored the frequency of swallowing measures outside the healthy reference range in adults with COPD. Method Participants were 28 adults aged 41-79 years (18 men, 20 women) with stable COPD. Disease severity was classified as GOLD (Global Initiative For Chronic Obstructive Lung Disease) Stages 1 (4%), 2 (25%), 3 (53%), and 4 (18%). Participants underwent a videofluoroscopy and swallowed 20% w/v thin barium in, followed by 20% w/v mildly, moderately, and extremely thick barium prepared with a xanthan gum thickener. Blinded duplicate ratings of swallowing safety, efficiency, kinematics, and timing were performed according to the ASPEKT method (Analysis of Swallowing Physiology: Events, Kinematics and Timing). Comparison data for healthy adults aged < 60 years were extracted from an existing data set. Chi-square and Fisher's exact tests compared the frequencies of measures falling < 1 / > 1 from mean reference values (or < the first or > the third quartile for skewed parameters). Results Participants with COPD did not display greater frequencies of penetration-aspiration, but they were significantly more likely ( < .05) to display incomplete laryngeal vestibule closure (LVC), longer time-to-LVC, and shorter LVC duration. They also displayed significantly higher frequencies of short upper esophageal sphincter opening, reduced pharyngeal constriction, and pharyngeal residue. Conclusion This analysis reveals differences in swallowing physiology in patients with stable COPD characterized by impaired safety related to the mechanism, timing, and duration of LVC and by impaired swallowing efficiency with increased pharyngeal residue related to poor pharyngeal constriction.
吞咽困难是慢性阻塞性肺疾病（COPD）的一种严重的肺外表现。然而，COPD 患者吞咽生理异常的性质尚未明确。我们探讨了 COPD 成人吞咽测量值超出健康参考范围的频率。方法：参与者为 28 名年龄在 41-79 岁的稳定期 COPD 成人（18 名男性，20 名女性）。疾病严重程度按 GOLD（全球慢性阻塞性肺疾病倡议）分期 1（4%）、2（25%）、3（53%）和 4（18%）进行分类。参与者进行了视频透视检查，并吞下 20% w/v 稀钡，然后吞下 20% w/v 稀钡、轻度、中度和极度浓钡，用黄原胶增稠剂制成。根据 ASPEKT 方法（吞咽生理分析：事件、运动学和时间）对吞咽安全性、效率、运动学和时间进行盲法重复评分。从现有的数据集提取了年龄<60 岁的健康成年人的对照数据。卡方和 Fisher 精确检验比较了<1/ >1 偏离均值参考值的测量值频率（或<偏态参数的第 1 四分位数或>第 3 四分位数）。结果：COPD 患者没有表现出更高的渗透-吸入频率，但他们更有可能（<0.05）表现出不完全的喉前庭闭合（LVC）、更长的 LVC 时间和更短的 LVC 持续时间。他们还表现出更高的短上食管括约肌开口频率、降低的咽缩肌收缩和咽后残留。结论：这项分析揭示了稳定期 COPD 患者吞咽生理的差异，其特点是与 LVC 的机制、时间和持续时间有关的安全性受损，以及与咽缩肌收缩不良有关的吞咽效率受损和咽后残留增加。
