COPD and dysphagia

Question 1

What is COPD?

Answer 1

• People who have COPD havedifficulty exhaling all the air out of their lungs. This resistance to airflow leads them to exhale air slowly, and they have more air left in their lungs, called air-trapping.
• Air-trapping leads to hyperinflation of the lungs, which pulls the larynx into a lower resting position = larynx has a longer way to travel to reach the epiglottis during a swallow.
• COPD also causes increase in inspiratory flow resistance and diminished elastic recoil.
• Retain CO2 leading to hypoxia = fatigue, difficulty carrying out daily activities.

Question 2

Effect of COPD on swallowing

Answer 2

• Muscle weakness
• Prolonged oral transit time
• Respiratory-swallow discoordination
• Increased time of laryngeal vestibule closure/LVC
• Incomplete/delayed LVC
• Longer duration of hyoid movement
• Pharyngeal residue
• Decreased sensation in oral cavity, pharynx and larynx

Aka COPD is associated with slower and less-complete movements of swallow muscles, decreased sensation, and impaired coordination between breathing and swallowing.

Question 3

COPD and dysphagia ax

Answer 3

• Chart review and case hx:
  
  • COPD symptoms
  • Recent exacerbations
  • GERD or LPR
  • Supplementary O2
  • CXr
• Asessment:
  
  • O2 saturation at baselines (<94%)
  • Resp rate at baseline (rapid RR is >25bpm)
  • Dyspnea (SOB) with speech/swallowing
  • Resp muscle strength
• Treatment:
  
  • Sit upright
  • Take breaks to conserve energy
  • Use pursed lip breathing
  • Take small bites and sips and allow more time for breathing
  • Eat and drink at a slow pace
  • Use an oral hold
  • Avoid breath-holding maneouvers
  • EMST