COPD and Dysphagia

COPD and Swallowing

The effects of COPD on swallowing are becoming increasingly well documented and it is thought that between 21-42% of people with COPD will experience symptoms of dysphagia. Conversely only 3-5% of people with COPD and dysphagia are thought to be referred for expert assessment and help.

Effects of COPD on swallowing

1. Faster breathing rate

• People with COPD are likely to need to breath more often in order to get the oxygen that they need.
• This may mean that need for oxygen may overrule the need to protect the airway during the swallow-breath cycle and so disrupt that cycle in order to take a breath.
• Any disruption to the swallow-breath cycle could lead to aspiration e.g. inhaling post swallow instead of exhaling.

2. Reduced lung capacity

• Swallowing is exaccerbated by the reduced lung volume that peole with COPD suffer from.
• Lung volume is thought to be involved in creating pressure in the airway that helps drive the swallow process.
• Reduced lung voulme will reduce the level of this pressure at the time of swallow and this alters the speed at which the swallow occurs.
• Consequently the swallow takes longer and is more likely to leave food and drink behind in the throat.
• Consequently, people with COPD would need to hold the breaths for longer during the swallow BUT they are less able to do so and so are more likely to disrupt the cycle and inhale mid-swallow.

3. Altered swallow-breathing cycle.

• People with COPD also show an altered swallow-breathing cycle to the one shown above.
• They are more likely to swallow during inhalation rather than exhalation.
• They are more likely to need to breath in as soon as the swallow has finished rather than resume exhaltion.
• This means there is a greater risk of inhaling food and drink that could lead to aspiration.

4. Weaker cough

• The body usually resonds to aspiration by coughing.
• People with COPD are more likely to have a weaker cough and so their cough may not be effective to clear food and drink out of the airway.

5. Secretions in throat

• Food and drink can “stick” to any chest secretions in the throat and be left behind after the swallow has finished to be inhaled at a later date 

Interestingly many of these symptoms are more likely to occur on foods that require chewing than semi-solid food or drinks. Presumably this is because chewing requires more effort and may increase shortness of breath. Softer foods therefore often have a reduced risk of aspiration.

Consequences of dysphagia

Increased risk of Aspiration/ aspiration related pneumonia.

A chest infection in a person with COPD may lead to an exacerbation of their COPD symptoms (shortness of breath etc.) which therefore further impacts on their swallowing.

As someone with COPD uses more energy to maintain breathing and oxygen levels during chewing and swallowing, eating and drinking can be tiring. As a result, drinking and eating meals take longer which can lead to eating and drinking less. Eating and drinking less would cause

• a drop in hydration levels which could lead to thicker secretions
• reduced levels of nutrition that could contribute to increased fatigue
• weight loss.

Signs of dysphagia

• Coughing or choking after swallowing food or drinks
• Increased shortness of breath during meals
• Wet or ‘gurgly’ voice after swallowing
• Feeling like food is getting stuck in the throat
• Difficulty chewing foods
• Taking longer to start a swallow
• Food or drink going into your nose