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Respiratory Medicine Aug 2016The precise coordination between breathing and swallowing is an important mechanism to prevent pulmonary aspiration. Factors that alter breathing patterns and... (Review)
Review
BACKGROUND
The precise coordination between breathing and swallowing is an important mechanism to prevent pulmonary aspiration. Factors that alter breathing patterns and ventilation, such as chronic respiratory diseases, may influence that precise coordination of breathing and swallowing.
PURPOSE
The purpose of this systematic literature review is to examine the effects of chronic respiratory diseases on swallowing function.
METHOD
Literature searches were performed using the electronic databases PubMed and Embase. All articles meeting the eligibility criteria up to March 2016 were included.
RESULTS
All articles included studied Chronic Obstructive Pulmonary Diseases (COPD) or Obstructive Sleep Apnea (OSA); no studies involving other respiratory diseases were found. A total of 1069 abstracts were retrieved, of which twenty-six studies met the inclusion criteria; eleven studies dealt with OSA and fifteen studies dealt with COPD.
CONCLUSION
The outcome data indicate that chronic respiratory diseases increase the prevalence of oropharyngeal dysphagia (OD) in patients. However, the relative small number of studies, differences in selection criteria, definitions and assessment techniques used for diagnosing OSA, COPD, and OD point to the need for further research.
Topics: Adult; Aged; Aged, 80 and over; Deglutition; Deglutition Disorders; Female; Humans; Male; Middle Aged; Prevalence; Pulmonary Disease, Chronic Obstructive; Respiration; Respiratory Aspiration; Sleep Apnea, Obstructive
PubMed: 27492514
DOI: 10.1016/j.rmed.2016.05.024 -
Jornal Brasileiro de Pneumologia :... 2018
Topics: Child; Female; Foreign Bodies; Humans; Lung, Hyperlucent; Respiratory Aspiration; Tomography, X-Ray Computed
PubMed: 30043881
DOI: 10.1590/S1806-37562018000000092 -
BMJ Case Reports Sep 2012
Topics: Aged; Anti-Bacterial Agents; Barium; Contrast Media; Deglutition Disorders; Humans; Male; Oxygen Inhalation Therapy; Radiography; Respiratory Aspiration
PubMed: 22962374
DOI: 10.1136/bcr.02.2012.5891 -
Lung Aug 2014Disordered swallowing, or dysphagia, is almost always present to some degree in people with Parkinson's disease (PD), either causing aspiration or greatly increasing the... (Comparative Study)
Comparative Study
BACKGROUND
Disordered swallowing, or dysphagia, is almost always present to some degree in people with Parkinson's disease (PD), either causing aspiration or greatly increasing the risk for aspiration during swallowing. This likely contributes to aspiration pneumonia, a leading cause of death in this patient population. Effective airway protection is dependent upon multiple behaviors, including cough and swallowing. Single voluntary cough function is disordered in people with PD and dysphagia. However, the appropriate response to aspirate material is more than one cough, or sequential cough. The goal of this study was to examine voluntary sequential coughing in people with PD, with and without dysphagia.
METHODS
Forty adults diagnosed with idiopathic PD produced two trials of sequential voluntary cough. The cough airflows were obtained using pneumotachograph and facemask and subsequently digitized and recorded. All participants received a modified barium swallow study as part of their clinical care, and the worst penetration-aspiration score observed was used to determine whether the patient had dysphagia.
RESULTS
There were significant differences in the compression phase duration, peak expiratory flow rates, and amount of air expired of the sequential cough produced by participants with and without dysphagia.
CONCLUSIONS
The presence of dysphagia in people with PD is associated with disordered cough function. Sequential cough, which is important in removing aspirate material from large- and smaller-diameter airways, is also impaired in people with PD and dysphagia compared with those without dysphagia. There may be common neuroanatomical substrates for cough and swallowing impairment in PD leading to the co-occurrence of these dysfunctions.
Topics: Aged; Aged, 80 and over; Cough; Deglutition Disorders; Female; Humans; Lung; Male; Middle Aged; Parkinson Disease; Peak Expiratory Flow Rate; Predictive Value of Tests; Respiratory Aspiration; Risk Factors; Volition
PubMed: 24792231
DOI: 10.1007/s00408-014-9584-7 -
Ear, Nose, & Throat Journal Jan 2020Foreign body aspiration (FBA) is a major cause of morbidity and mortality in children. It is a preventable event that predominates in preschool age. The signs and... (Comparative Study)
Comparative Study
BACKGROUND
Foreign body aspiration (FBA) is a major cause of morbidity and mortality in children. It is a preventable event that predominates in preschool age. The signs and symptoms mimic respiratory diseases common in the same age-group. We compared FBA in infants to FBA in older children.
METHODS
Retrospective analysis of all the cases of suspected FBA of children under the age of 18 years hospitalized at one medical center during 2002 to 2016. We analyzed the data according to age: up to 1 year (infants) and 1 to 18 years.
RESULTS
One hundred seventy-five children with suspected FBA were admitted; of whom, 27 (15%) were infants and 148 (85%) were older children (age 1-18 years). For the 2 age groups, adults witnessed 85% and 73%, respectively, of the incidents ( = .4). In the neonate group, 48% presented with normal X-ray findings compared to only 20% in the older group; 15% of the older group had a positive chest X-ray for a foreign body, while none had such in the infants' group ( = .01). For the 2 age groups, the majority of the FBs found were from organic origin. About half of the patients were diagnosed and managed within 24 hours of the aspiration event. In 10%, repeated bronchoscopy was performed due to a retained FB remnant. In a multivariate analysis, signs and symptoms ( < .05), location of the FB ( < .001), and witnessed aspiration ( < .001) were independent prognostic factors for the length of hospitalization.
CONCLUSION
Foreign body aspiration is not uncommon in young infants; the management is challenging due to small airways, the need to use smaller bronchoscopes, and the lack of working channel forces in pediatric bronchoscopes.
Topics: Adolescent; Bronchoscopy; Child; Child, Preschool; Female; Foreign Bodies; Humans; Infant; Male; Multivariate Analysis; Radiography; Respiratory Aspiration; Retrospective Studies
PubMed: 30974996
DOI: 10.1177/0145561319839900 -
Ear, Nose, & Throat Journal Sep 2021Dentures are worn by 20% of the United Kingdom population for both physical and psychological symptoms associated with tooth loss. However, significant morbidity and... (Review)
Review
INTRODUCTION
Dentures are worn by 20% of the United Kingdom population for both physical and psychological symptoms associated with tooth loss. However, significant morbidity and mortality can result if dentures are swallowed or aspirated. This 10-year review investigated the development of complications following denture aspiration or ingestion, and identified key learning points.
METHODS
The Medline database was searched for cases of denture ingestion or aspiration from October 1, 2009, to October 31, 2019. Search terms included "dental prosthesis, denture, dental plate, bridge and false teeth" and "swallow, ingest, eat, aspirate and inhale." Potential factors influencing the development of complications were assessed (hollow viscus perforation, fistula formation, abscess, bowel obstruction, necrosis, hemorrhage, and airway obstruction). Statistical analysis was performed using χ and Pearson correlation tests in R Studio. No ethical approval was required.
RESULTS
Eighty-five patients were identified from 77 case reports. Fourteen articles were excluded due to insufficient information. Complications were documented in 37.6% (n = 32) of patients with 2 cases resulting in death. Duration of symptoms over 1 day ( = .005) and delayed removal beyond 4 days post-ingestion ( = .017) was significantly associated with increased rates of complications. There was no significant association between complication rate and patient age, denture type, level of impaction, or radiolucency.
CONCLUSION
Denture aspiration or ingestion can have serious consequences. Factors impacting complication rate revolve around early recognition and treatment. Clinician awareness of the potential risks of dentures is paramount to early diagnosis. We recommend early intervention to reduce the morbidity associated with this unassuming device.
Topics: Dentures; Foreign Bodies; Humans; Respiratory Aspiration; United Kingdom
PubMed: 32293908
DOI: 10.1177/0145561320917529 -
The Laryngoscope Dec 2017The natural clinical progression of aspiration to eventual pulmonary compromise is not well understood. We hypothesized that dietary modification recommendations,...
OBJECTIVES/HYPOTHESIS
The natural clinical progression of aspiration to eventual pulmonary compromise is not well understood. We hypothesized that dietary modification recommendations, Penetration-Aspiration Scale (PAS) score, and dysphagia etiology would be associated with changes in time to first pulmonary event and overall survival for patients with documented aspiration on radiologic testing. This study identified a cohort of patients with detectable unsensed penetration or aspiration on videofluoroscopic swallowing study (VFSS), and followed this cohort over time for development of pulmonary events and death. We then evaluated the association of aspiration severity and dietary modification recommendations on incidence of these endpoints.
STUDY DESIGN
Retrospective chart review.
METHODS
A total of 2,616 VFSS exam reports were reviewed from our institution performed between January 1, 2009 and December 31, 2010. Aspiration or unsensed penetration (PAS of 5 or greater) was detected in 564 (21.5%) of these patients, who were then included in the study cohort. Medical records were reviewed retrospectively for development of pulmonary events (pneumonia, pneumonitis, or other life-threatening pulmonary illness) and all-cause mortality for up to 54 months after initial VFSS. Univariate Kaplan-Meier analysis and multivariate Cox regression were performed for time to first pulmonary event and survival predicted by recommended diet, PAS score, and dysphagia etiology.
RESULTS
Dysphagia etiology was highly associated with increased development of pulmonary events for some patients, especially those with generalized nonspecific dysphagia due to deconditioning or frailty (hazard ratio [HZ] vs. stroke 2.95, 95% confidence interval [CI]: 1.53-5.69, P = .001) and esophageal dysphagia (HZ: 2.66, 95% CI: 1.17-6.02, P = .019). Dysphagia etiology was also associated with increased mortality for patients with generalized nonspecific dysphagia due to deconditioning or frailty (HZ: 3.32, 95% CI: 2.0-5.52, P < .001), postsurgical patients (HZ: 1.73, 95% CI: 1.05-2.86, P = .032), and chronic neurologic disease (HZ: 1.87, 95% CI: 1.12-3.13, P = .017). Dietary modification recommendations at the time of VFSS (prohibition of oral intake or modification of food consistency) had no significant impact on time to first pulmonary event (P = .37) or survival (P = .17), whereas PAS score was associated with decreased time to first pulmonary event on univariate but not multivariate analysis (HZ for 1-point increase: 1.6, 95% CI: 0.99-1.36, P = .067). Kaplan-Meier estimate of overall 3-year mortality for this patient cohort was 39%.
CONCLUSIONS
Etiology of dysphagia is associated with a higher mortality rate and development of pulmonary events in patients with unsensed penetration or aspiration on VFSS, especially for those patients with generalized deconditioning and frailty or esophageal dysphagia. Severity of aspiration as defined by PAS was not associated with altered overall survival. Recommendations for dietary modification to a nothing by mouth status or modified food consistency had no statistically significant association with development of pulmonary events or survival in patients with detectable unsensed penetration or aspiration on VFSS compared to full-diet recommendation.
LEVEL OF EVIDENCE
4. Laryngoscope, 127:S1-S10, 2017.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Deglutition; Deglutition Disorders; Diet Therapy; Female; Fluoroscopy; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Pneumonia, Aspiration; Proportional Hazards Models; Regression Analysis; Respiratory Aspiration; Respiratory Insufficiency; Retrospective Studies; Severity of Illness Index; Video Recording; Young Adult
PubMed: 28884823
DOI: 10.1002/lary.26854 -
Anesthesiology Sep 2016
Review
Topics: Humans; Point-of-Care Testing; Respiratory Aspiration; Stomach; Ultrasonography
PubMed: 27529853
DOI: 10.1097/ALN.0000000000001043 -
The European Respiratory Journal Mar 2009The diagnostic value of various signs and symptoms (clinical markers) in predicting oropharyngeal aspiration (OPA) or swallowing dysfunction has not been established in...
The diagnostic value of various signs and symptoms (clinical markers) in predicting oropharyngeal aspiration (OPA) or swallowing dysfunction has not been established in children. The present retrospective study was undertaken to: 1) identify specific clinical markers associated with radiographic evidence of OPA, isolated laryngeal penetration (ILP) and post-swallow residue (PSR); 2) determine the sensitivity and specificity of clinical markers associated with OPA; and 3) determine the influence of age and neurological impairment on clinical markers of OPA. In total, 11 clinical markers of dysphagia were compared with the videofluoroscopic swallow study (VFSS) results (OPA, ILP and PSR) in 150 children on diets of thin fluid and purée consistencies. Chi-squared and logistic regression were used to analyse the association between clinical markers and VFSS-identified swallowing dysfunction. In children with OPA, wet voice (odds ratio (OR) 8.90, 95% confidence interval (CI) 2.87-27.62), wet breathing (OR 3.35, 95% CI 1.09-10.28) and cough (OR 3.30, 95% CI 1.17-9.27) were significantly associated with thin fluid OPA. Predictive values included: wet voice (sensitivity 0.67; specificity 0.92); wet breathing (sensitivity 0.33; specificity 0.83); and cough (sensitivity 0.67; specificity 0.53). No clinical markers were significantly associated with OPA, ILP or PSR on the purée consistency. Cough was significantly associated with PSR on thin fluids (OR 3.59, 95% CI 1.22-10.55). Differences were found for age. Wet voice, wet breathing and cough were good clinical markers for children with oropharyngeal aspiration on thin fluid but not on purée. Age and neurological status influenced the significance of these clinical markers.
Topics: Child; Child, Preschool; Deglutition; Deglutition Disorders; Female; Humans; Infant; Infant, Newborn; Male; Multivariate Analysis; Odds Ratio; Oropharynx; Respiratory Aspiration; Retrospective Studies; Sensitivity and Specificity
PubMed: 19010985
DOI: 10.1183/09031936.00090308 -
The Laryngoscope Jul 2019Contrast agent (CA) aspiration is an established complication of upper gastrointestinal and videofluoroscopic swallow studies. The underlying molecular biological...
OBJECTIVES/HYPOTHESIS
Contrast agent (CA) aspiration is an established complication of upper gastrointestinal and videofluoroscopic swallow studies. The underlying molecular biological mechanisms of acute response to CA aspiration in the respiratory organs remain unclear. The aims of this study were to elucidate the histological and biological influences of three kinds of CAs on the lung and to clarify the differences in acute responses.
STUDY DESIGN
Animal model.
METHODS
Eight-week-old male Sprague Dawley rats were divided into five groups (n = 6 in each group). Three groups underwent tracheal instillation of one of three different CAs: barium (Ba) sulfate, nonionic contrast agents (NICAs), and ionic contrast agents (ICAs). A control group was instilled with saline and a sham group was instilled with air. All animals were euthanized on day 2 after treatment and histological and gene analysis was performed.
RESULTS
No animal died after CA or control/sham aspiration. Ba caused severe histopathologic changes and more prominent inflammatory cell infiltration in the lungs compared with the two other iodinated contrast agents. Increases in expressions of inflammatory cytokines (tumor necrosis factor [Tnf], interleukin-1β [Il1b], and interferon-γ [Ifng]) were observed in Ba aspiration rats, and upregulation of Il1b was seen in ICA aspiration rats. NICA did not cause obvious histologic changes or expressions of inflammatory cytokines and fibrosis-related genes in the lungs.
CONCLUSIONS
Ba caused significantly more acute lung inflammation in a rodent model than did ioinic and nonionic iodinated CAs. Nonionic contrast did not cause any discernible inflammatory response in the lungs, suggesting that it may be the safest contrast for videofluoroscopic swallow studies.
LEVEL OF EVIDENCE
NA Laryngoscope, 129:1533-1538, 2019.
Topics: Animals; Barium Sulfate; Contrast Media; Cytokines; Disease Models, Animal; Inflammation; Lung; Male; Photofluorography; Rats; Rats, Sprague-Dawley; Respiratory Aspiration
PubMed: 30467858
DOI: 10.1002/lary.27663