Chronic Obstructive Pulmonary Disease and Dysphagia: What Have We Learned So Far and What Do We Still Need to Investigate?

Abstract

Purpose Dysphagia is an underrecognized concern in people with chronic obstructive pulmonary disease (COPD) and may contribute to disease exacerbations. In this review article, we share information regarding dysphagia in people with COPD, synthesizing knowledge both from the literature and from studies performed in the context of a multidisciplinary clinical pulmonary rehabilitation program at the Federal University of Santa Maria in Brazil. Results This narrative review presents evidence showing that awareness of dysphagia and patient-reported symptoms of dysphagia are rare in individuals with stable COPD. However, evidence from the routine collection of patient-reported symptom data using the Eating Assessment Tool 10 and about dysphagia-related quality of life using the Swallowing Quality of Life questionnaire do suggest that dysphagia is experienced by some individuals with COPD. Several studies suggest that patients with stable COPD present with altered swallowing physiology on videofluoroscopic exams, including silent aspiration in a small number of these individuals. However, both patient self-report and clinical screening using the Volume–Viscosity Swallowing Test have been found to be poor predictors of these videofluoroscopic findings. We discuss the possibility that altered laryngeal sensation and respiratory–swallow discoordination play a role in dysphagia in people with COPD, and highlight assessment tasks that appear to have the highest sensitivity for detecting penetration–aspiration in this population. Finally, we review preliminary evidence suggesting that physical therapy techniques targeting altered respiratory muscle biomechanics may benefit swallowing in people with COPD. Knowledge gaps requiring further research are identified, and implications for clinical practice are discussed.