Oropharyngeal dysphagia in COPD patients

Chronic respiratory diseases are known to increase the prevalence of oropharyngeal dysphagia (OD), especially in COPD patients. It could induce severe complications as pulmonary infections or malnutrition, which increase the morbidity and the mortality. Nevertheless, in COPD patients, the mechanism of oropharyngeal dysphagia is unclear, and we aimed to identified if it was due to a default of propulsion of the bolus or to a default of protection of upper airway. We prospectively studied the deglutition of severe COPD patients (gold III or IV) admitted in rehabilitation center after an acute respiratory decompensation. 28 patients (age 69±8 y,12 f) were studied using a clinical screening test of oropharyngeal dysphagia validated in geriatric population with a high sensitivity and a high specificity (V-VST). Our results demonstrated that 11 (39%) patients had an oropharyngeal dysphagia (abnormal V-VST). In those patients, 9 had a default of airway protection and 7 had a lake of bolus propulsion (5 had both). There was no difference between patients with normal deglutition and patients with abnormal deglutition regarding age, gold score, FEV1 or VC. There presented all frequent exacerbations, chronic cough and rest dyspnea. This preliminary study demonstrated that oropharyngeal dysphagia is frequent in severe COPD patients, with a lack of airway protection. This dysphagia is not explained by age or functional respiratory data. Discussion about the mechanisms implicated will be discussed during the presentation.