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Original Research: COPD |

Abnormal Swallowing Reflex and COPD Exacerbations

Kunihiko Terada, MD, PhD; Shigeo Muro, MD, PhD; Tadashi Ohara, MD, PhD; Megumi Kudo, MD; Emiko Ogawa, MD, PhD; Yuma Hoshino, MD, PhD; Toyohiro Hirai, MD, PhD; Akio Niimi, MD, PhD; Kazuo Chin, MD, PhD; Michiaki Mishima, MD, PhD
Author and Funding Information

From the Department of Respiratory Medicine (Drs Terada, Muro, Ohara, Kudo, Ogawa, Hoshino, Hirai, Niimi, and Mishima), and the Department of Respiratory Care and Sleep Control Medicine, Graduate School of Medicine (Dr Chin), Kyoto University, Kyoto, Japan.

Correspondence to: Shigeo Muro, Department of Respiratory Medicine, Kyoto University, 54, Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan; e-mail: smuro@kuhp.kyoto-u.ac.jp


Funding/Support: This work was supported in part by the Japan Society for the Promotion of Science [Grants A 18209029 and B 16390234] from the Japanese Respiratory Society for the Promotion of Science and a grant to the Respiratory Failure Research Group from the Ministry of Health, Labour and Welfare, Japan.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).


© 2010 American College of Chest Physicians


Chest. 2010;137(2):326-332. doi:10.1378/chest.09-0482
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Background:  It is unclear whether an abnormal swallowing reflex affects COPD exacerbations. This study investigated the prevalence of abnormal swallowing reflexes and its relationship with COPD exacerbation prospectively. We also clarified its association with gastroesophageal reflux disease (GERD) and airway bacterial colonization.

Methods:  Swallowing reflex and serum C-reactive protein (CRP) levels were examined in subjects with stable COPD and in control subjects. Concurrently, GERD symptoms were assessed using a self-reported questionnaire, and sputum bacterial cultures were investigated in the same subjects. Exacerbations were counted prospectively during the following 12 months.

Results:  The study group comprised 67 subjects with COPD and 19 controls. The prevalence of abnormal swallowing reflex was significantly higher in subjects with COPD (22/67) than controls (1/19; P = .02). Among subjects with COPD, the serum CRP level, GERD symptoms, isolation of sputum bacteria, and the frequency of exacerbations were significantly increased in those with abnormal swallowing reflexes compared with controls (2.72 vs 1.04 mg/L, P = .04, for serum CRP level; 6.75 vs 4.10 points, P = .04, for GERD symptoms; 5/11 vs 3/22, P = .04, for the isolation of sputum bacteria; and 2.82 vs 1.56/y, P = .007, for the annual frequency of exacerbations). Multivariable analysis confirmed that abnormal swallowing reflex was significantly associated with frequent exacerbations (≥ 3/y; P = 0.01).

Conclusions:  Abnormal swallowing reflexes frequently occurred in subjects with COPD and predisposed them to exacerbations. Abnormal swallowing reflexes in COPD might be affected by the comorbidity of GERD, and cause bacterial colonization.

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