[Dysphagia] Bronchospasm

[chris_claire at bigpond.com (Chris and Claire Langdon)]

Hi Sharon

I'm not able to answer your question about bronchospasm, but I wonder, does your patient by any chance have symptoms of reflux?  There's an article by Casanova et.al. Eur Respir J. 2004 Jun;23(6):841-5 Increased gastro-oesophageal reflux disease in patients with severe COPD which found 62% of COPD patients had reflux (see abstract below)

The prevalence and clinical consequences of gastro-oesophageal reflux disease (GERD) in chronic obstructive pulmonary disease (COPD) are not well characterised. The present study prospectively studied 42 males with COPD (forced expiratory volume in one second % predicted: 35%, range 20-49) and 16 healthy volunteers of similar age without respiratory or gastro-oesophageal symptoms. The diagnosis of GERD was confirmed using oesophageal 24 h pH monitoring. In the current study group, reflux symptoms were measured using the Vigneri score, cough and dyspnoea with the modified Medical Research Council questionnaire, and pulmonary function with bronchodilator response and health status using St George's Respiratory Questionnaire. Pathological reflux was documented in 26 out of 42 patients (62%) and in three volunteers (19%). In patients with GERD, 15 patients (58%) did not report any reflux symptoms. There were no differences in symptoms, health status, bronchodilator treatment and pulmonary function test between patients with and without GERD. Oxygen desaturation coincided with episodes of increased oesophageal acidity in 40% of patients with GERD. Patients with severe chronic obstructive pulmonary disease have a high prevalence of asymptomatic gastro-oesophageal reflux. The association between this reflux and oxygen desaturation deserves further attention.

The article by Susan Langmore in 1998 found that 50% of patients with both COPD and GERD in their sample developed aspiration pneumonia.
Langmore, S.E., Terpenning, M.S., Schorck, A., Chen, Y., Murray, J.T., Lopatin, D., Loesche, W.J., Predictors of aspiration pneumonia: How important is dysphagia? Dysphagia, 1998. 13: p. 69-81. 

See also 
Mokhlesi B, Logemann JA, Rademaker AW, Stangl CA, Corbridge TC. Oropharyngeal deglutition in stable COPD Chest. 2002 Feb;121(2):361-9.STUDY OBJECTIVES: The aim of this study was to examine deglutition in stable patients with COPD and lung hyperinflation. DESIGN: Twenty consecutive, eligible COPD patients with an FEV(1) < or = 65% of predicted and a total lung capacity > or = 120% of predicted were enrolled prospectively. INTERVENTION: Patients received a detailed videofluoroscopic evaluation of oropharyngeal swallowing and were compared to 20 age-matched and sex-matched historical control subjects. SETTING: An outpatient pulmonary clinic at a Veterans Affairs Medical Center. MEASUREMENTS AND RESULTS: The mean total lung capacity, functional residual capacity, and residual volume for the patients were 128% of predicted, 168% of predicted, and 218% of predicted, respectively. The mean FEV(1) was 39% of predicted. There was no evidence of tracheal aspiration in either group. The laryngeal position at rest measured relative to the cervical vertebrae was not different between groups. The maximal laryngeal elevation during swallowing was significantly lower in patients with COPD (p < 0.001). Patients with COPD exhibited more frequent use of spontaneous protective swallowing maneuvers such as longer duration of airway closure and earlier laryngeal closure relative to the cricopharyngeal opening than did control subjects (p < 0.05). CONCLUSIONS: We conclude that hyperinflated patients with COPD have an altered swallowing physiology. We suspect that the protective alterations in swallowing physiology (swallow maneuvers) may reduce the risk of aspiration. However, these swallowing maneuvers may not be useful during an exacerbation and may require further research.


Cheers

Claire
----- Original Message ----- 
From: "Sharon Manders" <cmandersn223@rogers.com>
To: <dysphagia@b9.com>
Sent: Tuesday, April 26, 2005 8:57 AM
Subject: [Dysphagia] Bronchospasm


> Hi,
> 
> I have a question for the group. One of our respirologists has recently 
> been asking me if bronchospasm can worsen or cause aspiration. We have 
> a patient who has COPD and on his last very recent admit, one of my 
> colleagues saw him and found no dysphagia. I saw him this time and his 
> breathing was much worse and the respirologist asked me to reassess. 
> The patient's lungs had been okay on discharge, but he was back just a 
> few days later for a recurrence of his COPD/exacerbation. The MD was 
> running out of ideas as to why and we were both thinking that since his 
> breathing was so horrible that this may have been causing difficulty 
> when swallowing. It turns out today that some MD over the weekend 
> figured out he had epiglottitis and after a course of antibiotics was 
> started on the weekend, he is now doing very much better.
> 
> My main question remains: can bronchospasm cause aspiration? It seems 
> quite possible to me. Anyone have any particular experience, or could 
> recommend some articles or a place to start? A medline search for 
> bronchospasm, dysphagia, deglutition disorders and bronchial spasm only 
> gave me 6 articles, none of which were particularly helpful.
> 
> Also, are people seeing epiglottitis very often?
> 
> Thanks in advance,
> 
> Sharon 
> 
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