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Oropharyngeal Dysfunction in COPD Patients : The Need for Clinical Research

Susan M. Harding, MD, FCCP
Author and Funding Information

Affiliations: Birmingham, AL 
 ,  Dr. Harding is Associate Professor of Medicine, Division of Pulmonary Allergy and Critical Care Medicine, University of Alabama at Birmingham.

Correspondence to: Susan M. Harding, MD, FCCP, Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, 1900 University Blvd, THT Rm 215, Birmingham, AL 35294; e-mail: sharding@uab.edu



Chest. 2002;121(2):315-317. doi:10.1378/chest.121.2.315
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As chest physicians, we evaluate oropharyngeal function in patients in whom we suspect aspiration, including those with a history of stroke, Parkinson’s disease, motor neuron disease, myasthenia, myopathies and other central and peripheral nervous system diseases, and in patients with oropharyngeal structural abnormalities, selected systemic diseases, and recent endotracheal extubation. However, the association between pulmonary parenchymal diseases, including COPD, and oropharyngeal function has not been examined in a systematic manner. Swallowing is a complex physiologic process involving four consecutive phases (oral preparatory, oral voluntary, pharyngeal, and esophageal) utilizing > 30 muscles.1 The precise timing and coordination of swallowing is vital for bolus transfer into the esophagus and for airway protection. There is also an interdependence between respiration and swallowing that is under complex voluntary and involuntary control. In this issue of CHEST (see page 361), Mokhlesi et al hypothesize that patients with hyperinflation from COPD have altered oropharyngeal function, including a lower laryngeal resting position and a decrease in laryngeal elevation, potentially predisposing to aspiration. Utilizing videofluoroscopic techniques in 20 COPD patients and in 20 historical control subjects, the maximum laryngeal elevation during swallowing was significantly lower in the COPD patients. Patients with COPD also used spontaneous protective swallowing maneuvers more frequently than the historical control subjects. This preliminary study has design flaws, including the use of historical control subjects, and the potential presence of confounding variables. However, despite these flaws, the study does support the need for further research to determine whether COPD is associated with perturbed function of the oropharynx leading to episodes of aspiration. Whether these episodes have a role in COPD exacerbations and lung function decline remains to be determined.

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