NYUMC, New York, NY
Copyright 2016, American College of Chest Physicians. All Rights Reserved.
SESSION TITLE: Chest Infections
SESSION TYPE: Original Investigation Poster
PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM
PURPOSE: Non-tuberculous mycobacteria (NTM) can cause asymptomatic infection of the lungs as well as clinically significant lung disease. NTM is often associated with destructive changes of the airways that can lead to impairment of quality of life. It is unknown whether impaired swallowing contributes to the pathophysiology of NTM. Micro-aspiration occurs in normal individuals and its prevalence is higher in lung diseases such as COPD, asthma, obstructive sleep apnea, and lung infections due to typical and atypical microorganisms (such as non-tuberculous mycobacteria). It is possible that patients with NTM may exhibit decreased airway protection causing risk for micro-aspiration during thin liquid swallows. The objective of this study was to determine airway protection in 3 and 5ml thin liquid swallows in patients with newly diagnosed NTM
METHODS: Videofluoroscopy (VF) was collected from 41 newly diagnosed patients with NTM (11 male) aged 55-87. Two boluses of 3 and 5ml thin liquid Varibar were analyzed per subject (N=164 swallows). The primary interest was airway protection as measured by the Penetration Aspiration Scale (PAS). The PAS is an eight-point validated scale that captures the depth of airway invasion. Scores of 1 are considered normal while scores of 2- 8 represent increasing level of impairment.
RESULTS: Inter- and intra-rater reliability of PAS ratings were assessed using two-way mixed intraclass correlation coefficients (ICC) on 20% of the data with excellent results (intra-rater: ICC = 0.98, 95%CI = 0.95-0.98 and inter-rater: ICC = 0.85, 95%CI = 0.69-0.92).The grand mean for PAS was 1.38 (SD = 0.99). The proportion of impaired swallows in the whole dataset was 19.5 % (32/164 swallows with PAS scores ≥2). Similar pattern regardless of bolus volume was noted (3ml versus 5 ml). It was apparent that the proportion of subjects with at least one unsafe swallow PAS (≥2 ) was 41.5%.
CONCLUSIONS: Patients with NTM appear to have impaired swallow function as represented by impaired airway protection. Future work should explore swallowing physiology in this population.
CLINICAL IMPLICATIONS: Swallowing function and airway protection may be compromized on patient s with NTM
DISCLOSURE: The following authors have nothing to disclose: Matina Balou, Sonja Molfenter, Joanna Smith, Melissa Lumish, Danielle Brates, Jeremy Feintuch, Joshua Feintuch, David Kamelhar
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