scholarly journals Tongue strength and swallowing dynamics in chronic obstructive pulmonary disease

2021 ◽  
pp. 00192-2021
Author(s):  
Isabella Epiu ◽  
Simon C. Gandevia ◽  
Claire L. Boswell-Ruys ◽  
Emma Wallace ◽  
Jane E. Butler ◽  
...  

BackgroundSwallowing disorders occur in chronic obstructive pulmonary disease (COPD), but little is known about tongue strength and mastication. This is the first assessment in COPD of tongue strength and a test of mastication and swallowing solids (TOMASS).MethodsAnterior tongue strength measures were obtained in 18 people with COPD, aged 73±11 years (mean±sd), and 19 healthy age-matched controls, aged 72±6 years. Swallowing dynamics were assessed using an eating assessment tool (EAT-10), timed water swallow test (TWST), and TOMASS. Swallowing measures were compared to an inhibitory reflex in the inspiratory muscles to airway occlusion (IR; recorded previously in the same participants).ResultsTongue strength was similar between COPD and controls (p=0.715). Self-assessed scores of dysphagia EAT-10 were higher (p=0.024) and swallowing times were prolonged for liquids (p=0.022) and solids (p=0.003) in the COPD group. During TWST, ∼30% of COPD group showed clinical signs of airway invasion (cough and wet voice), but none in the control group. For solids, the COPD group had ∼40% greater number of chews (p=0.004), and two-fold-higher number of swallows (p=0.0496). Respiratory rate was 50% higher in COPD group than controls (p <0.001). The presence of an IR was not related to better swallowing outcomes, but signs of airway invasion were associated with a delayed IR.ConclusionDysphagia in stable COPD is not due to impaired anterior tongue strength, but rather swallowing-breathing discoordination. To address dysphagia, aspiration, and acute exacerbations in COPD, therapeutic targets to improve swallowing dynamics could be investigated further.

2020 ◽  
Vol 29 (2) ◽  
pp. 864-872
Author(s):  
Fernanda Borowsky da Rosa ◽  
Adriane Schmidt Pasqualoto ◽  
Catriona M. Steele ◽  
Renata Mancopes

Introduction The oral cavity and pharynx have a rich sensory system composed of specialized receptors. The integrity of oropharyngeal sensation is thought to be fundamental for safe and efficient swallowing. Chronic obstructive pulmonary disease (COPD) patients are at risk for oropharyngeal sensory impairment due to frequent use of inhaled medications and comorbidities including gastroesophageal reflux disease. Objective This study aimed to describe and compare oral and oropharyngeal sensory function measured using noninstrumental clinical methods in adults with COPD and healthy controls. Method Participants included 27 adults (18 men, nine women) with a diagnosis of COPD and a mean age of 66.56 years ( SD = 8.68). The control group comprised 11 healthy adults (five men, six women) with a mean age of 60.09 years ( SD = 11.57). Spirometry measures confirmed reduced functional expiratory volumes (% predicted) in the COPD patients compared to the control participants. All participants completed a case history interview and underwent clinical evaluation of oral and oropharyngeal sensation by a speech-language pathologist. The sensory evaluation explored the detection of tactile and temperature stimuli delivered by cotton swab to six locations in the oral cavity and two in the oropharynx as well as identification of the taste of stimuli administered in 5-ml boluses to the mouth. Analyses explored the frequencies of accurate responses regarding stimulus location, temperature and taste between groups, and between age groups (“≤ 65 years” and “> 65 years”) within the COPD cohort. Results We found significantly higher frequencies of reported use of inhaled medications ( p < .001) and xerostomia ( p = .003) in the COPD cohort. Oral cavity thermal sensation ( p = .009) was reduced in the COPD participants, and a significant age-related decline in gustatory sensation was found in the COPD group ( p = .018). Conclusion This study found that most of the measures of oral and oropharyngeal sensation remained intact in the COPD group. Oral thermal sensation was impaired in individuals with COPD, and reduced gustatory sensation was observed in the older COPD participants. Possible links between these results and the use of inhaled medication by individuals with COPD are discussed.


Author(s):  
Somayeh Ghadimi ◽  
Atefeh Fakharian ◽  
Mohsen Abedi ◽  
Reyhaneh Zahiri ◽  
Mahsan Norouz Afjeh ◽  
...  

Background: Chronic Obstructive Pulmonary Disease (COPD) leads to limited activity and reduced quality of life. Treatment of this disease is a long-term process that requires the cooperation of patients in monitoring and treatment. Methods: In the present study which was conducted from April 2019 to March 2021 in Masih Daneshvari Hospital, Tehran, Iran, 75 patients were randomly divided into telerehabilitation and control groups. Patients in the control group received pulmonary rehabilitation including respiratory, isometric, and aerobic exercises for 8 weeks, three times per week. In the second group, patients were given a lung rehabilitation booklet and asked to repeat the exercises three times a week for four weeks according to a specific schedule. In addition, patients installed Behzee care application on the mobile phone that recorded various indicators such as heart rate, SpO2, dyspnea, fatigue, and daily activities. This application reminded the patient of the program every day and at a specific time. Finally, the patients’ conditions were compared in the two groups after 8 weeks using CAT and mMRC questionnaires and 6-Minute Walk (6MW) exercise indices as well as spirometry tests. Results: In all four indicators (6MW, CAT,  and mMRC questionnaires as well as spirometry), patients showed improvement after rehabilitation (p<0.001). This improvement was significantly higher in the telemedicine group compared to the other group (p<0.01). Conclusion: The use of telerehabilitation in COPD patients is effective in improving spirometry indices, quality of life, as well as activity and sports indices.


2019 ◽  
Vol 39 (2) ◽  
pp. 103-112
Author(s):  
Maratus Sholihah ◽  
Suradi Suradi ◽  
Jatu Aphridasari

Introduction: Chronic obstructive pulmonary disease (COPD) is the leading cause of morbidity and mortality worldwide. Cigarette smoke and noxious agent result in oxidative stress and activate release of inflammatory mediators such as Interleukin-8 (IL-8). Quercetin is a flavonoid compound containing anti-inflammatory effects which can be used as an adjuvant therapy in stable COPD. Objective: To analyze the effect of quercetin on serum IL-8 levels, % VEP1, and CAT score of stable COPD patients. Methods: Experimental clinical trial with pre-test and pasca-test design was performed in 30 patients with stable COPD in Dr. Moewardi Surakarta between December 2017 and January 2018. The samples taken by using purposive sampling were divided into two groups treatment groups received standard therapy and quercetin 500mg/day for 28 days and control groups only received standard therapy. The decrease in inflammation was measured by serum IL-8 examination, improvement of obstruction measured by %FEV1 and clinical improvement measured by CAT score. Results: IL-8 serum level was significantly lower in treatment group than of in control group (p=0,001). The percentage of FEV1 was insignificant different between the two group (p=0,236). However CAT score was significantly lower in treatment group compared to that of in control group (p=0,001) Conclusions: Quercetin can decrease IL-8 serum level and decrease CAT score when given in combination with standard therapy for COPD patients. (J Respir Indo 2019; 39(2))


2018 ◽  
Vol 7 (1) ◽  
Author(s):  
Lei Liu ◽  
Bin Liu

<p class="16"><em>Background and Objective: Pneumatic nebulizers (PN) are commonly used to treat COPD. We aimed to evaluate and compare two PNs with respect to effectiveness and delivery, and the effect of using a membrane filter to prevent drug wastage.</em><em></em></p><p><em>Methods: COPD patients (240) were divided into an experimental group (EG); treated with a YZB/GEM1058-2009 medical atomizer, and a control group (CG); treated with a DNA100 medical atomizer. A polypropylene membrane was then applied to each nebulizer.</em><em></em></p><p class="16"><em>Results: Wastage per inhalation was 79.56% in the EG, and 87% in the CG and reduced to 35.3% in the EG and 42.1% in the CG following application of a polypropylene membrane. </em><em>The  ratio of drug not atomised </em><em>per inhalation was 10.32% in the EG, and 24.52% in the CG and altered to 30.2% and 37.3% with the polypropylene membrane. </em><em> </em><em>The total effective rate, cure rate and weekly efficiency were 96.7%, 73.3% and 93.3%, respectively in the EG, and 93.3%, 60% and 83.3% respectively in the CG, and increased to 100%, 93.3% and 100%, respectively in the EG, and 100%, 83.3% and 93.3%, respectively, in the CG with the membrane application. The number of days required to be effective was 4±2.4 days in the EG, and 7±3.8 in the CG and decreased to 3±1.4 in the EG, and 5±3.1 in the CG with the membrane. </em><em></em></p><p class="16"><em>Conclusions</em><em>: There was a high percentage of drug wastage with both PNs. YZB/GEM1058-2009 was significantly more effective than DNA100 but a </em><em>polypropylene </em><em>microporous membrane significantly improved the effectiveness of both.</em><em></em></p><p class="16"><em>Keywords: Chronic Obstructive Pulmonary Disease; Pneumatic Nebulizer; </em><em>Drug waste; Polypropylene microporous membrane</em><em></em></p>


2019 ◽  
Author(s):  
Esther Helen Steveling-Klein ◽  
Claudia Gerhards ◽  
Caroline Zaehringer ◽  
Nebal Abu Hussein ◽  
Selina Dürr ◽  
...  

Abstract Background: Prevalence and impact of chronic rhinosinusitis (CRS) in chronic obstructive pulmonary disease (COPD) remain unclear. We hypothesized that CRS is more frequent in patients with COPD compared to controls and we aimed to evaluate the odds of CRS in both groups. Methods: We recruited patients with COPD and a healthy control group in a tertiary referral hospital in Switzerland. Diagnosis of CRS was defined according to published guidelines and supported by computed tomography (CT) findings. Sino-nasal-outcome-test-20 (SNOT-20) and sino-nasal-outcome-test-primary-nasal-symptom-score (SNOT-PNS-score) were self-assessed with a cut-off for abnormality of >12. Results: Data from 83 COPD patients (35 females, age: 67 years ± 10) and 34 controls (18 females, age: 67 years ± 12) were analyzed. In the COPD group 14 out of 83 (20.3%) fulfilled the diagnosis of CRS compared to only 1 out of 34 (3%) in the control group (OR 6.7; 95% CI 0.84-53.10; p = 0.064). Forty-eight COPD patients (59%) and 14 controls (41%) had an abnormal SNOT-20 score (OR 1.96; 95% CI 0.87-4.40; p=0.10), with a median score of 16.0 (ICR 21) in COPD patients compared to a median score of 8.0 (ICR 13) in controls (p=0.001). The SNOT-PNS-score was abnormal in 49 COPD patients (59%) and in 9 controls (26%) (OR 4.00; 95% CI 1.66-9.64; p=0.001). Abnormal findings of the upper airways did not correlate with COPD severity or smoking status. Conclusions: CRS was a frequent diagnosis in patients with COPD. CRS reduces quality of life in this patient group.


2020 ◽  
Vol 2 (1) ◽  
Author(s):  
Rifat Saba ◽  
Nadeem Hafeez ◽  
Muhammad Zain-ul-Abideen ◽  
Muhammad Abdullah Nabeel

Objective: To investigate the impact of self-management intervention on the effectiveness of emotional regulation in patients suffering from chronic obstructive pulmonary disease (COPD). Materials and Methods: This study was conducted in the Pulmonology Department of Jinnah hospital Lahore in Collaboration with community medicine department for Six months duration from March 2018 to August 2018. 86 consecutive chronic COPD patients were diagnosed in the stable phase. 43 patients in each group were divided into a control group and a randomized observation group. In the control group, the continuous feeding mode outside of a conventional hospital and an enhanced guide to self-care programs in the observation group (information about the disease, breathing exercises, emotions, home oxygen therapy, medication technique, healthy life behaviors and deteriorating action plans) were used to compare differences in results. Results: For six-month follow-up visits, personal hygiene behavior, physical education, cognitive symptoms and management of medical care results, and observation groups in both groups were more visible and the differences were statistically significant (p <0.05); Self-regulation of emotions regulation in two groups was increased, including positive effect, deterrence / anguish, anger / irritation and total results. In addition, the extent of growth in the observation group was clearer and the differences were statistically significant (p <0.05). Conclusion: intervention of the self-monitoring program can improve the self-control behavior of patients with COPD and is important for improving the effectiveness of regulation and prediction of emotions.


2019 ◽  
Vol 4 (6) ◽  
pp. e001921
Author(s):  
Max Oscar Bachmann ◽  
Eric D Bateman ◽  
Rafael Stelmach ◽  
Alvaro A Cruz ◽  
Matheus Pacheco de Andrade ◽  
...  

IntroductionThe Practical Approach to Care Kit (PACK) guide was localised for Brazil, where primary care doctors and nurses were trained to use it.MethodsTwenty-four municipal clinics in Florianópolis were randomly allocated to receive outreach training and the guide, and 24 were allocated to receive only the guide. 6666 adult patients with asthma or chronic obstructive pulmonary disease (COPD) were enrolled, and trial outcomes were measured over 12 months, using electronic medical records. The primary outcomes were composite scores of treatment changes and spirometry, and new asthma and COPD diagnosis rates.ResultsAsthma scores in 2437 intervention group participants were higher (74.8%, 20.4% and 4.8% with scores of 0, 1 and 2, respectively) than in 2633 control group participants (80.0%, 16.8% and 3.2%) (OR for higher score 1.32, 95% CI 1.08 to 1.61, p=0.006). Adjusted for asthma scores recorded in each clinic before training started, the OR was 1.24 (95% CI 1.03 to 1.50, p=0.022). COPD scores in 1371 intervention group participants (77.7%, 17.9% and 4.3% with scores of 0, 1 and 2) did not differ from those in 1181 control group participants (80.5%, 15.8% and 3.7%) (OR 1.21, 95% CI 0.94 to 1.55, p=0.142). Rates of new asthma and COPD diagnoses, and hospital admission, and indicators of investigation, diagnosis and treatment of comorbid cardiovascular disease, diabetes and depression, and tobacco cessation did not differ between trial arms.ConclusionPACK training increased guideline-based treatment and spirometry for asthma but did not affect COPD or comorbid conditions, or diagnosis rates.Trial registrationNCT02786030 (https://clinicaltrials.gov/).


BMJ Open ◽  
2020 ◽  
Vol 10 (5) ◽  
pp. e032931
Author(s):  
Pooja Saini ◽  
Tanith Rose ◽  
Jennifer Downing ◽  
Bashir Matata ◽  
Samantha Pilsworth ◽  
...  

ObjectiveTo examine the effects of a consultant-led, community-based chronic obstructive pulmonary disease (COPD) service, based in a highly deprived area on emergency hospital admissions.DesignA longitudinal matched controlled study using difference-in-differences analysis to compare the change in outcomes in the intervention population to a matched comparison population, 5 years before and after implementation.SettingA deprived district in the North West of England between 2005 and 2016.InterventionA community-based, consultant-led COPD service providing diagnostics, treatment and rehabilitation from 2011 to 2016.Main outcome measuresEmergency hospital admissions, length of stay per emergency admission and emergency readmissions for COPD.ResultsThe intervention was associated with 24 fewer emergency COPD admissions per 100 000 population per year (95% CI −10.6 to 58.8, p=0.17) in the postintervention period, relative to the control group. There were significantly fewer emergency admissions in populations with medium levels of deprivation (64 per 100 000 per year; 95% CI 1.8 to 126.9) and among men (60 per 100 000 per year; 95% CI 12.3 to 107.3).ConclusionWe found limited evidence that the service reduced emergency hospital admissions, after an initial decline the effect was not sustained. The service, however, may have been more effective in some subgroups.


Author(s):  
Yuksel Kaplan ◽  
Handan Inonu ◽  
Ayse Yilmaz ◽  
Serpil Ocal

Objective:To evaluate the prevalence of restless legs syndrome (RLS) in patients with chronic obstructive pulmonary disease (COPD) and the relationship between RLS and clinical/laboratory findings of COPD.Methods:One hundred and thirty-four COPD patients without secondary causes of RLS were included. Thirty-nine (29.1%) patients were diagnosed with RLS and classified as Group 1. The control group consisted of 65 age-matched COPD patients without RLS. Group 1 was divided into subgroups according to the Johns Hopkins Severity (JHS) scale. Patients with a score of 0, 1, or 2 were classified as JHS 0-2 and those with a score of 3 as JHS 3. Group 1 and the control group and subgroups were compared for clinical and laboratory characteristics.Results:We found that the duration of COPD was longer and that airway obstruction, hypercapnia, and hypoxia were more evident in patients with RLS than those without. Similar differences were also detected between JHS subgroups 3 (more severe) and 0-2. Polyneuropathy frequency was significantly higher in Group 1 compared to controls. However, Group 1 subgroups showed a similar frequency of polyneuropathy. In a multivariate analysis, hypercapnia made a significant independent contribution to both JHS 0-2 and JHS 3 patients when RLS severity was set as the dependent variable. Polyneuropathy and the duration of COPD were significant independent variables for patients in the JHS 3 subgroup. Polyneuropathy was the strongest predictor for the JHS 3 patients.Conclusions:We conclude that RLS is frequent in COPD, particularly in patients with severe hypoxemia/hypercapnia and in late stages of the disease.


2020 ◽  
Vol 48 (8) ◽  
pp. 030006052094550
Author(s):  
Jia Yang ◽  
Junchao Yang

Objective This study aimed to evaluate the effect of clearing heat and resolving phlegm for acute exacerbation of chronic obstructive pulmonary disease with the syndrome of phlegm-heat obstruction of the lung. Methods This was a real-world retrospective cohort study of inpatients at our institution from 1 January 2015 to 31 December 2017. The patients were divided into two groups according to whether they received oral traditional Chinese medicine (TCM) for clearing heat and resolving phlegm or routine treatment (controls). Efficacy and safety indicators were analyzed. Propensity score matching was used to control for confounding factors. Results Among 488 patients, 164 (82 pairs) were successfully matched. The changes in neutrophils (%) and C-reactive protein levels were more significant in the TCM group than in the control group. The duration of fever was significantly shorter in the TCM group than in the control group. Conclusions The therapy of clearing heat and resolving phlegm might effectively control the inflammatory reaction of acute exacerbation of chronic obstructive pulmonary disease in patients with the syndrome of phlegm-heat obstruction of the lung, especially for those with fever. Nevertheless, large-scale and prospective studies are required to provide a higher quality of evidence.


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