1. 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.

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

3. 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.

4. 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

5. 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

6. 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

7. 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
seconds.
Margareta Gonzalez Lindh

8. 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  .

9. 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

10. 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

11. 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 s Chair-stand test during 30 seconds (p=0,01) - Time to walk 30 meters at maximal speed (p=0,04)

12. 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.

13. 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

14. 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