How do COPD patients perceive their swallowing? Prevalence of subjective swallowing dysfunction in patients with stable COPD – Results from the TIE study Gonzalez Lindh, Margareta1,2, Malinovschi, Andrei3 , Högman, Marieann3, Bendrik, Regina2,, Lisspers, Karin4, Ställberg, Björn4, Blom Johansson, Monica1, Koyi, Hirsh2 1Dept of Neuro Science, Uppsala University, Sweden ²Centre for Research & Development, Uppsala University/Region Gävleborg, Sweden ³Dept.of Medical Sciences, Uppsala University, Uppsala, Sweden 4Dept of Public Health and Caring Science Medicine, Uppsala University, Sweden.

Speech-Language Pathologist at Gävle Hospital, Sweden Ph.D. student at the Dept of Neuro Science, Uppsala University

TIE = Tools Identifying Exacerbations Prospective multicenter study in primary- and secondary care 3 counties in Mid-Sweden: Gävleborg, Dalarna, Uppsala General Aim: Knowledge into which factors predict an exacerbation in COPD-patients TIE is a prospectiv cohort study. We are still including patients. The goal is to include 600 participants. Follow ups are one and two years after baseline. We do a number of tests, for example, spirometry with reversibility tests, NO, blood samples, BMI, some physical tests and ask about drugs and use the questionnaires CAT and CCQ . I will present baselinedata today.

The TIE study - Specific aim Investigate the prevalence of subjective swallowing dysfunction (oropharyngeal dysphagia) Determine the relation to COPD disease stage (GOLD), gender, exacerbations and physical activity

Effects of COPD on Swallowing - Background Relatively new but growing research area. What effects does a disturbed coordination of the breathing – swallowing pattern have - on the ability to swallow safely Margareta Gonzalez Lindh

Effects of COPD on Swallowing Research is also looking at the relationship between dysphagia and increased exacerbations (worsening or a "flare up“) Exacerbations lead to a worsening of the disease and an increased mortality

Coordination breathing - swallowing Shared anatomic and physiologic substrates. Linked physiologically as swallow interrupts respiration. Allow precise coordination of both events in tandem, and for a separation of function Normal swallow: short apnea 0.5 - 1.5 seconds. Margareta Gonzalez Lindh

Demographic data & Method 336 patients (58% women) were included Spirometry verified COPD diagnosis Information about self reported swallowing dysfunction from the TIE study questionnaire: 1. Food gets stuck in my throat when I swallow 2. I cough when I eat 3. I choke when I eat and drink Physical capacity was measured through a 30 s Chair-stand test and time to walk 30 meters at m maximal velocity  .

Results 117 patients (35%) experienced a swallowing dysfunction. No difference between men and women. Median age, range: 70 år (50-84) for both groups, p=0,90. Perceived swallowing dysfunction was found in all stages of the disease (GOLD 1-4), p=0,58

Table 1. Distribution of patients experiencing oropharyngeal dysphagia according to COPD disease stage (GOLD) GOLD stage All patients (n) Patients with OPD (n) % of OPD I 23 11 44 II 185 61 33 III 94 35 37 IV 34 10 29 Summary 335 117

Results No relationship between swallowing dysfunction and acute visits due to self-reported respiratory problems (p=0,93) or exacerbations (p=0,59) during last year Patients with dysphagia had a poorer physical capacity - 30 s Chair-stand test during 30 seconds (p=0,01) - Time to walk 30 meters at maximal speed (p=0,04)

Conclusion Swallowing dysfunction is more commonly experienced by COPD patients than by the general geriatric population:15-22% (Aslam 2013). In this preliminary analysis there was a correlation between self reported swallowing dysfunction and decreased physical capacity.

Future This interesting finding of self reported dysphagia needs to be validated by swallowing tests Speech pathologists are trained to diagnose and treat oropharyngeal dysphagia and could potentially play an important role in the multi disciplinary management of COPD

Thank you from the TIE-study´s researchers & PhD-students* Gävleborg: Marieann Högman Kristina Bröms Hirsh Koyi Eva Brandén Johanna Sulku* Regina Bendrik* Alexandra Thornadtsson* Margareta Gonzalez Lindh* Uppsala Andrei Malinovschi Hans Hedenström Christer Janson Jens Ellingsen* Dalarna Karin Lisspers Björn Ställberg Uppsala universitet Jonas Lundkvist margareta.gonzalez.lind@regiongavleborg.se