Pulmonary Rehabilitation in Patients with Dysphagia = Pulmonary Rehabilitation in Patients with Dysphagia
저자
발행기관
대한결핵 및 호흡기학회(The Korean Academy of Tuberculosis and Respiratory Diseases)
학술지명
권호사항
발행연도
2021
작성언어
-주제어
KDC
500
자료형태
학술저널
수록면
181-182(2쪽)
제공처
The function of swallowing is very complex in humans. Swallowing not only plays an important role in food digestion, but also plays a critical role in preventing the aspiration of food and/or other substances into the lower respiratory tract. To achieve this, precise coordination between breathing and swallowing is required as the pharynx acts as a common pathway for breathing and digestion. The swallowing reflex consists of afferent pathways, central integration, and efferent pathways. Any defects along the reflex arc can cause swallow dysfunction. Among these, timing of swallows may be the most important factor that determines the occurrence of pulmonary aspiration, since phases of inspiration and the expiration-inspiration transition are the most vulnerable for pulmonary aspiration.
Dysphagia has a Greek etymology, and it means the state of being unable (dys-) to swallow (phagia). Dysphagia is one of the main complications associated with aspiration pneumonia. With increases in older adult populations, dysphagia causing aspiration pneumonia and nutritional impairment is a growing problem. Dysphagia can be caused by a wide variety of diseases. In general, it is divided into the disease group that involves the nervous system and the group that does not. Dysphagia that do not involves the nervous system are most often caused by anatomical structural changes, and head and neck tumors such as laryngeal or oral cancer are representative. In addition, dysphagia in respiratory diseases including COPD is reported with varying frequencies of 20-92%. In COPD patients, food aspiration is recognized as a risk factor for repeated acute exacerbations, pneumonia, and pulmonary fibrosis. Patients with COPD have impaired coordination between respiration and swallowing and are more likely to commence swallowing and resume respiration in the inspiratory phase, both in the chronic state as well as during exacerbations of the disease. Reported characteristics of dysphagia in people with COPD include oral and pharyngeal stasis, delayed swallow reflex, reduced laryngeal elevation during swallowing, cricopharyngeal dysfunction, laryngeal penetration and aspiration.
Postextubation dysphagia (PED) is a common problem in critically ill patients with recent intubation. Although several risk factors have been identified, most of them are non-modifiable preexisting or concurrent conditions. Advanced age, prolonged mechanical ventilation, preexisting congestive heart failure, forced supine position, the presence of tracheostomy, nasogastric tube placement have been associated with a higher risk of developing PED. These conditions may also be experienced in acute exacerbation of COPD or severe postoperative pulmonary complications in lung cancer. In addition, acute dysphagia is occurred frequently during concurrent chemo-radiation or high-dose radiotherapy for lung cancer.
With greater focus in modern medicine on quality of life, the importance of accurate swallowing assessment with appropriate evaluation tools is drawing greater attention. Videofluoroscopic swallowing study (VFSS) and fiberoptic endoscopic evaluation of swallowing (FEES) are well known and widely used diagnostic tools for dysphagia.
VFSS provides a real-time view of oral, pharyngeal, and cervical esophageal phases of swallowing, and FEES is useful for direct visualization of the anatomy of the nasopharynx and supraglottic structures. Dysphagia treatment is focused on nutritional status, hydration, and reducing morbidity from pneumonia. There are several major therapeutic options for Dysphagia: dietary texture modifications, postural changes/compensatory maneuvers, and interventions to improve swallow function, therapeutic exercises, and neuromuscular stimulation.
Dysphagia education, screening, and management in a pulmonary rehabilitation program can improve participants’ swallowing related quality of life and overall self-management of chronic respiratory disease and dysphagia.
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