Aspiration and severe exacerbations in COPD: a prospective study
Rationale Swallow may be compromised in COPD leading to aspiration and adverse respiratory consequences. However, prevalence and consequences of detectable aspiration in stable COPD are not known. Objectives We tested the hypothesis that a significant number of patients with stable COPD will have de...
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doaj-b49c77f8c0494e0ba5f3fe46f54533b42021-04-06T10:24:09ZengEuropean Respiratory SocietyERJ Open Research2312-05412021-01-017110.1183/23120541.00735-202000735-2020Aspiration and severe exacerbations in COPD: a prospective studyLydia Cvejic0Nadine Guiney1Tiffany Nicholson2Kenneth K. Lau3Paul Finlay4Kais Hamza5Christian Osadnik6Paul Leong7Martin MacDonald8Paul T. King9Philip G. Bardin10 Monash Lung and Sleep, Monash Health, Melbourne, Australia Monash Lung and Sleep, Monash Health, Melbourne, Australia Diagnostic Imaging, Monash Health, Melbourne, Australia School of Clinical Sciences, Monash University, Melbourne, Australia Monash Lung and Sleep, Monash Health, Melbourne, Australia School of Mathematical Sciences, Monash University, Melbourne, Australia Monash Lung and Sleep, Monash Health, Melbourne, Australia Monash Lung and Sleep, Monash Health, Melbourne, Australia Monash Lung and Sleep, Monash Health, Melbourne, Australia Monash Lung and Sleep, Monash Health, Melbourne, Australia Monash Lung and Sleep, Monash Health, Melbourne, Australia Rationale Swallow may be compromised in COPD leading to aspiration and adverse respiratory consequences. However, prevalence and consequences of detectable aspiration in stable COPD are not known. Objectives We tested the hypothesis that a significant number of patients with stable COPD will have detectable aspiration during swallow (prandial aspiration) and that they would experience more frequent severe acute exacerbations of COPD (AECOPD) over the subsequent 12 months. Methods Patients (n=151) with verified and stable COPD of all severities were recruited at a tertiary care hospital. Videofluoroscopy was conducted to evaluate aspiration using Rosenbek's scale for penetration–aspiration during 100-mL cup drinking. AECOPD was documented as moderate (antibiotics and/or corticosteroid treatment) or severe (emergency department admission or hospitalisation) over the ensuing 12 months. Measurements and main results Aspiration was observed in 30 out of 151 patients (19.9%, 18 males, 12 females; mean age 72.4 years). Patients with aspiration had more overall AECOPD events (3.03 versus 2 per patient; p=0.022) and severe AECOPD episodes (0.87 versus 0.39; p=0.032). Severe AECOPD occurred in more patients with aspiration (50% of patients versus 18.2%; OR 4.5, CI 1.9–10.5; p=0.001) and with silent aspiration (36.7% versus 18.2%; OR 2.6, CI 1.1–6.2; p=0.045). Aspiration was related to a shorter exacerbation-free period during the 12-month follow-up period (p=0.038). Conclusions Prandial aspiration is detectable in a subset of patients with COPD and was predictive of subsequent severe AECOPD. Studies to examine if the association is causal are essential to direct strategies aimed at prevention of aspiration and AECOPD.http://openres.ersjournals.com/content/7/1/00735-2020.full |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Lydia Cvejic Nadine Guiney Tiffany Nicholson Kenneth K. Lau Paul Finlay Kais Hamza Christian Osadnik Paul Leong Martin MacDonald Paul T. King Philip G. Bardin |
spellingShingle |
Lydia Cvejic Nadine Guiney Tiffany Nicholson Kenneth K. Lau Paul Finlay Kais Hamza Christian Osadnik Paul Leong Martin MacDonald Paul T. King Philip G. Bardin Aspiration and severe exacerbations in COPD: a prospective study ERJ Open Research |
author_facet |
Lydia Cvejic Nadine Guiney Tiffany Nicholson Kenneth K. Lau Paul Finlay Kais Hamza Christian Osadnik Paul Leong Martin MacDonald Paul T. King Philip G. Bardin |
author_sort |
Lydia Cvejic |
title |
Aspiration and severe exacerbations in COPD: a prospective study |
title_short |
Aspiration and severe exacerbations in COPD: a prospective study |
title_full |
Aspiration and severe exacerbations in COPD: a prospective study |
title_fullStr |
Aspiration and severe exacerbations in COPD: a prospective study |
title_full_unstemmed |
Aspiration and severe exacerbations in COPD: a prospective study |
title_sort |
aspiration and severe exacerbations in copd: a prospective study |
publisher |
European Respiratory Society |
series |
ERJ Open Research |
issn |
2312-0541 |
publishDate |
2021-01-01 |
description |
Rationale
Swallow may be compromised in COPD leading to aspiration and adverse respiratory consequences. However, prevalence and consequences of detectable aspiration in stable COPD are not known.
Objectives
We tested the hypothesis that a significant number of patients with stable COPD will have detectable aspiration during swallow (prandial aspiration) and that they would experience more frequent severe acute exacerbations of COPD (AECOPD) over the subsequent 12 months.
Methods
Patients (n=151) with verified and stable COPD of all severities were recruited at a tertiary care hospital. Videofluoroscopy was conducted to evaluate aspiration using Rosenbek's scale for penetration–aspiration during 100-mL cup drinking. AECOPD was documented as moderate (antibiotics and/or corticosteroid treatment) or severe (emergency department admission or hospitalisation) over the ensuing 12 months.
Measurements and main results
Aspiration was observed in 30 out of 151 patients (19.9%, 18 males, 12 females; mean age 72.4 years). Patients with aspiration had more overall AECOPD events (3.03 versus 2 per patient; p=0.022) and severe AECOPD episodes (0.87 versus 0.39; p=0.032). Severe AECOPD occurred in more patients with aspiration (50% of patients versus 18.2%; OR 4.5, CI 1.9–10.5; p=0.001) and with silent aspiration (36.7% versus 18.2%; OR 2.6, CI 1.1–6.2; p=0.045). Aspiration was related to a shorter exacerbation-free period during the 12-month follow-up period (p=0.038).
Conclusions
Prandial aspiration is detectable in a subset of patients with COPD and was predictive of subsequent severe AECOPD. Studies to examine if the association is causal are essential to direct strategies aimed at prevention of aspiration and AECOPD. |
url |
http://openres.ersjournals.com/content/7/1/00735-2020.full |
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