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BMJ Open Respir Res. 2017 Jun 4;4(1):e000202. doi: 10.1136/bmjresp-2017-000202. eCollection 2017.

Breathing-swallowing discoordination is associated with frequent exacerbations of COPD.

Author information

1
Department of Neurology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
2
Department of Physiology, Hyogo College of Medicine, Nishinomiya, Japan.
3
Clinical Research Center for Medical Equipment Development (CRCMeD), Kyoto University Hospital, Kyoto, Japan.
4
Department of Swallowing Physiology, Hyogo College of Medicine, Nishinomiya, Japan.
5
Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
6
Department of Biomedical Statistics and Bioinformatics, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
7
Department of Health Sciences, Prefectural University Hiroshima, Hiroshima, Japan.
8
Department of Respiratory Medicine, Chest Disease Clinical and Research Institute, Kishiwada City Hospital, Kishiwada, Japan.

Abstract

INTRODUCTION:

Impaired coordination between breathing and swallowing (breathing-swallowing discoordination) may be a significant risk factor for the exacerbation of chronic obstructive pulmonary disease (COPD). We examined breathing-swallowing discoordination in patients with COPD using a non-invasive and quantitative technique and determined its association with COPD exacerbation.

METHODS:

We recruited 65 stable outpatients with COPD who were enrolled in our prospective observational cohort study and did not manifest an apparent swallowing disorder. COPD exacerbation was monitored for 1 year before and 1 year after recruitment. Swallowing during inspiration (the I-SW pattern) and swallowing immediately followed by inspiration (the SW-I pattern) were identified.

RESULTS:

The mean frequency of the I-SW and/or SW-I patterns (I-SW/SW-I rate) was 21.5%±25.5%. During the 2-year observation period, 48 exacerbation incidents (25 patients) were identified. The I-SW/SW-I rate was significantly associated with the frequency of exacerbation. During the year following recruitment, patients with a higher I-SW/SW-I frequency using thicker test foods exhibited a significantly higher probability of future exacerbations (p=0.002, log-rank test).

CONCLUSIONS:

Breathing-swallowing discoordination is strongly associated with frequent exacerbations of COPD. Strategies that identify and improve breathing-swallowing coordination may be a new therapeutic treatment for patients with COPD.

KEYWORDS:

COPD Exacerbations; Lung Physiology; Respiratory Measurement

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