Clinical Practice Patterns of Speech-Language Pathologists Delivering Dysphagia Services to Persons with COPD: Analysis of Survey Outcomes

Abstract

Swallowing impairments co-occur with chronic obstructive pulmonary disease (COPD) leading to aspiration, disease exacerbations, and malnutrition. This pilot survey study aimed to identify current clinical practice patterns for swallowing evaluation and treatment in persons with COPD. A 35-question Qualtrics survey was deployed to medical speech-language pathology (SLP) social media sites and professional boards; flyers were distributed at a professional conference. Forty-eight SLPs completed the study. SLPs routinely include a clinical swallow examination (96%), videofluoroscopic swallowing study (79%), adjunctive respiratory measures (respiratory rate [83%], and pulse oximetry [67%], respiratory–swallow pattern [77%]) but less frequently include fiberoptic endoscopic evaluation of swallowing (23%). Self-reported advanced clinical experience and expert respiratory analysis skills were associated with adjunctive respiratory measure (respiratory rate, pulse oximetry) inclusion during assessment. Compensatory strategy training (77%) is a preferred treatment for dysphagia in COPD; however, respiratory–swallow pattern training and expiratory muscle strength training are increasing in use. SLPs self-report a comprehensive, individualized patient-centered care approach with inclusion of adjunctive respiratory-focused methods in dysphagia evaluation and treatment practice in persons with COPD. Advances in the identification of the integral role of respiratory function in swallowing integrity may be translating to clinical practice methods for dysphagia management in persons with COPD.

Keywords

dysphagia - clinical practice patterns - chronic obstructive pulmonary disease - swallowing disorders - respiratory disease

Publikationsverlauf

Artikel online veröffentlicht:
02. November 2021

• References

• 1 Sullivan J, Pravosud V, Mannino DM, Siegel K, Choate R, Sullivan T. National and state estimates of COPD morbidity and mortality - United States, 2014-2015. Chronic Obstr Pulm Dis (Miami) 2018; 5 (04) 324-333
• 2 National Heart, Lung and Blood Institute. Morbidity and Mortality: 2007 Chartbook on Cardiovascular, Lung, and Blood Diseases. Bethesda, MD: U.S. Department of Health and Human Services; 2007
• 3 Donaldson GC, Seemungal TAR, Bhowmik A, Wedzicha JA. Relationship between exacerbation frequency and lung function decline in chronic obstructive pulmonary disease. Thorax 2002; 57 (10) 847-852
• 4 Dalal AA, Shah M, D'Souza AO, Rane P. Costs of COPD exacerbations in the emergency department and inpatient setting. Respir Med 2011; 105 (03) 454-460
• 5 Halpin DM, Decramer M, Celli B, Kesten S, Liu D, Tashkin DP. Exacerbation frequency and course of COPD. Int J Chron Obstruct Pulmon Dis 2012; 7: 653-661
• 6 Martinez CH, Mannino DM, Divo MJ. Defining COPD-related comorbidities, 2004–2014. Chronic Obstr Pulm Dis (Miami) 2014; 1 (01) 51-63
• 7 McKinstry A, Tranter M, Sweeney J. Outcomes of dysphagia intervention in a pulmonary rehabilitation program. Dysphagia 2010; 25 (02) 104-111
• 8 Garand KL, Strange C, Paoletti L, Hopkins-Rossabi T, Martin-Harris B. Oropharyngeal swallow physiology and swallowing-related quality of life in underweight patients with concomitant advanced chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis 2018; 13: 2663-2671
• 9 Good-Fratturelli MD, Curlee RF, Holle JL. Prevalence and nature of dysphagia in VA patients with COPD referred for videofluoroscopic swallow examination. J Commun Disord 2000; 33 (02) 93-110
• 10 Cvejic L, Harding R, Churchward T. et al. Laryngeal penetration and aspiration in individuals with stable COPD. Respirology 2011; 16 (02) 269-275
• 11 Mokhlesi B, Logemann JA, Rademaker AW, Stangl CA, Corbridge TC. Oropharyngeal deglutition in stable COPD. Chest 2002; 121 (02) 361-369
• 12 Marik PE, Kaplan D. Aspiration pneumonia and dysphagia in the elderly. Chest 2003; 124 (01) 328-336
• 13 Terada K, Muro S, Ohara T. et al. Abnormal swallowing reflex and COPD exacerbations. Chest 2010; 137 (02) 326-332
• 14 Gross RD, Atwood Jr CW, Ross SB, Olszewski JW, Eichhorn KA. The coordination of breathing and swallowing in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2009; 179 (07) 559-565
• 15 Clayton NA, Carnaby GD, Peters MJ, Ing AJ. Impaired laryngopharyngeal sensitivity in patients with COPD: the association with swallow function. Int J Speech Lang Pathol 2014; 16 (06) 615-623
• 16 Coelho CA. Preliminary findings on the nature of dysphagia in patients with chronic obstructive pulmonary disease. Dysphagia 1987; 2 (01) 28-31
• 17 de Deus Chaves R, Chiarion Sassi F, Davison Mangilli L. et al. Swallowing transit times and valleculae residue in stable chronic obstructive pulmonary disease. BMC Pulm Med 2014; 14: 62
• 18 Stein M, Williams AJ, Grossman F, Weinberg AS, Zuckerbraun L. Cricopharyngeal dysfunction in chronic obstructive pulmonary disease. Chest 1990; 97 (02) 347-352
• 19 Hårdemark Cedborg AI, Bodén K, Witt Hedström H. et al. Breathing and swallowing in normal man–effects of changes in body position, bolus types, and respiratory drive. Neurogastroenterol Motil 2010; 22 (11) 1201-1208 , e316
• 20 Martin-Harris B, Brodsky MB, Michel Y, Ford CL, Walters B, Heffner J. Breathing and swallowing dynamics across the adult lifespan. Arch Otolaryngol Head Neck Surg 2005; 131 (09) 762-770
• 21 Martin-Harris B, Brodsky MB, Price CC, Michel Y, Walters B. Temporal coordination of pharyngeal and laryngeal dynamics with breathing during swallowing: single liquid swallows. J Appl Physiol (1985) 2003; 94 (05) 1735-1743
• 22 Paydarfar D, Gilbert RJ, Poppel CS, Nassab PF. Respiratory phase resetting and airflow changes induced by swallowing in humans. J Physiol 1995; 483 (Pt 1): 273-288
• 23 Preiksaitis HG, Mills CA. Coordination of breathing and swallowing: effects of bolus consistency and presentation in normal adults. J Appl Physiol (1985) 1996; 81 (04) 1707-1714
• 24 Shaker R, Li Q, Ren J. et al. Coordination of deglutition and phases of respiration: effect of aging, tachypnea, bolus volume, and chronic obstructive pulmonary disease. Am J Physiol 1992; 263 (5, Pt 1): G750-G755
• 25 Hopkins-Rossabi T, Curtis P, Temenak M, Miller C, Martin-Harris B. Respiratory phase and lung volume patterns during swallowing in healthy adults: a systematic review and meta-analysis. J Speech Lang Hear Res 2019; 62 (04) 868-882
• 26 Barczi SR, Sullivan PA, Robbins J. How should dysphagia care of older adults differ? Establishing optimal practice patterns. Semin Speech Lang 2000; 21 (04) 347-361
• 27 Plowman EK, Tabor LC, Wymer J, Pattee G. The evaluation of bulbar dysfunction in amyotrophic lateral sclerosis: survey of clinical practice patterns in the United States. Amyotroph Lateral Scler Frontotemporal Degener 2017; 18 (5-6): 351-357
• 28 Rumbach A, Coombes C, Doeltgen S. A survey of Australian dysphagia practice patterns. Dysphagia 2018; 33 (02) 216-226
• 29 Martin-Harris B. Optimal patterns of care in patients with chronic obstructive pulmonary disease. Semin Speech Lang 2000; 21 (04) 311-321 , quiz 320–321
• 30 Martino R, Pron G, Diamant NE. Oropharyngeal dysphagia: surveying practice patterns of the speech-language pathologist. Dysphagia 2004; 19 (03) 165-176
• 31 Yañez AM, Guerrero D, Pérez de Alejo R. et al. Monitoring breathing rate at home allows early identification of COPD exacerbations. Chest 2012; 142 (06) 1524-1529
• 32 Britton D, Roeske A, Ennis SK, Benditt JO, Quinn C, Graville D. Utility of pulse oximetry to detect aspiration: an evidence-based systematic review. Dysphagia 2018; 33 (03) 282-292
• 33 Colodny N. Effects of age, gender, disease, and multisystem involvement on oxygen saturation levels in dysphagic persons. Dysphagia 2001; 16 (01) 48-57
• 34 Steele CM, Cichero JA. Physiological factors related to aspiration risk: a systematic review. Dysphagia 2014; 29 (03) 295-304
• 35 Park HJ, Cho JH, Kim HJ, Park JY, Lee HS, Byun MK. The effect of low body mass index on the development of chronic obstructive pulmonary disease and mortality. J Intern Med 2019; 286 (05) 573-582
• 36 Wagner PD. Possible mechanisms underlying the development of cachexia in COPD. Eur Respir J 2008; 31 (03) 492-501
• 37 Brooks M, McLaughlin E, Shields N. Expiratory muscle strength training improves swallowing and respiratory outcomes in people with dysphagia: a systematic review. Int J Speech Lang Pathol 2019; 21 (01) 89-100
• 38 Figueiredo RIN, Azambuja AM, Cureau FV, Sbruzzi G. Inspiratory muscle training in COPD. Respir Care 2020; 65 (08) 1189-1201
• 39 Martin-Harris B, McFarland D, Hill EG. et al. Respiratory-swallow training in patients with head and neck cancer. Arch Phys Med Rehabil 2015; 96 (05) 885-893