COPD and Speech Pathology - Slide 2

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					Chronic Obstructive
Pulmonary Disease
and Speech
4 Year Speech Pathology Pass Degree Project
Jessica Hayward, Julia Kawanishi, Stephanie Coleman, Kristy McLean, Patience Scott and
Bethany Hanley under the supervision of Robyn O’Halloran and Lydia Cvejic
Understanding COPD

• Chronic Obstructive Pulmonary Disease is an umbrella term
  to describe various chronic lung diseases that cause airflow
  limitation1,including chronic bronchitis and emphysema

• The main symptoms of COPD are breathlessness, chronic
  coughing, and production of phlegm2

• COPD is currently the leading cause of disease burden in
 Understanding COPD
• Cigarette smoking is the predominant cause of COPD in 80 to
  90% of cases

• Diagnosis of COPD is made with the use of pulmonary
  function tests

• Diseases such as bronchiectasis and cardiovascular disease
  commonly overlap with COPD

• Multiple interventions and medications may be needed to
  manage COPD
Understanding COPD

• Management aims to prevent symptoms or disease
  progression, prevent recurrent exacerbations and
  complications, preserve optimal lung function and improve
  quality of life

• Speech Pathologists should be educating and assisting their
  clients to effectively self-manage their communication and
  swallowing issues

• It is important for people with COPD to establish a solid
  understanding of their condition and its management
Role of the Speech Pathologist
• Speech Pathologists play an important role in the
  multidisciplinary management of COPD

• Speech Pathologists can assist with:
   – swallowing difficulties
   – vocal changes, and
   – oral hygiene issues associated with COPD

• Speech Pathologists must also consider the implications of
  various contributing factors to COPD which may induce or
  exacerbate symptoms. These include monitoring:
   – gastro-oesophageal reflux disease (GORD)
   – nutrition
 COPD and Swallowing
• Dysphagia and COPD can often coexist. As swallowing and
  respiration involve the same anatomical structures,
  dysfunction in one may lead to compromised function in the

• Oropharyngeal dysphagia is under diagnosed in patients with

• Individuals with COPD can present with a number of different
  eating and swallowing complaints and behaviours including:
   – limited oral intake
   – taking longer with meals7
   – sensation of food sticking in throat
   – increased breathing effort during mealtimes8
 COPD and Swallowing
• A number of physiological changes and symptoms are evident
  in all various stages of swallowing and affect the swallowing
  efficiency and airway protection in people with COPD

• The causes of dysphagia among patients with COPD have
  been linked to;
   – physiological changes (such as muscle fatigue, tongue
     weakness and hypoxia)
   – increased prevalence of xerostomia along with it’s
     associated issues (such as problems with taste, the
     increased viscosity of secretions and denture retention)
   – gastro-oesophageal reflux disease (GORD)
   – side effects of medications
   – oral and oesophageal candidiasis
COPD and Swallowing
• The effects of dysphagia and the incoordination between
  swallowing and respiration in patients with COPD place them
  at a higher risk of aspiration, aspiration pneumonia5,6,7and
  exacerbation of COPD symptoms

• Dysphagia can also have other negative consequences which
  could impact on quality of life and nutrition in people with
  COPD. These may result in feelings of anxiety at mealtimes,
  avoiding desirable food and avoiding eating in public7

• In the management of swallowing in people with COPD there
  are extensive suggestions. These include:
   – sit upright during mealtimes
   – choose softer foods to avoid excessive chewing
   – use of saliva replacement (dry mouth) products
COPD & Voice
• COPD can affect vocal quality and production, both directly
  and indirectly. These voice problems can be associated with
  other concurrent symptoms of COPD, such as respiratory
  decline or GORD, or as an effect of medication

• Vocal problems associated with COPD most commonly
  present as a hoarse vocal quality, or decreased volume

• Vocal problems associated with COPD should be managed in
  relation to their cause

• Management usually involves behavioural changes,
  avoidance of irritants, or alterations in medication delivery
COPD and Oral Hygiene

• Oral health issues are common among diagnoses of COPD

• Poor oral health associated with COPD can present as:
   – candida,
   – dental decay, or
   – most commonly, xerostomia (dry mouth)

• In COPD, the major causes of oral health issues are:
   – persistent mouth breathing and
   – the use of medications such as inhaled corticosteroids or
 COPD and Oral Hygiene
• As well as being an issue in itself, oral health problems can
  negatively impact upon swallowing function and safety, and
  voice production. It can also contribute to, or exacerbate,
  other symptoms common to COPD

• Oral health screening tools (eg Oral Health Assessment Tool
  (OHAT) 9 or Bethlehem Oral Health Screening Test
  (OHST)10)and saliva testing (eg GC Saliva Check Buffer) are
  useful in helping identify and manage oral health problems

• Strategies for managing poor oral health must be tailored to
  the individuals’ needs and consider the cause of the problem
  for that particular client
• Speech Pathologists play an important role in the
  multidisciplinary approach to the management of COPD and
  therefore must consider the implications of GORD in
  individuals who have COPD

• GORD must be considered when managing COPD, due to the
   – GORD may contribute to compromised airways and
   – GORD is known to be a contributing factor to
      exacerbations and can induce symptoms of COPD11,12
   – dysphagia associated with GORD may further impact upon
      swallowing function in patients with COPD.
COPD and Nutrition

• Maintenance of adequate nutrition is critical in the
  management of COPD

• Speech Pathologists have a role in the management
  of nutrition in COPD through ensuring that the
  person’s swallowing function is optimal
Further Information
• For a more comprehensive examination of COPD and Speech
  Pathology please refer to our website.


• Whilst exploring the site you will also find:
  – a literature review
  – various downloadable resources for patients (e.g.
  – reference list
  – this presentation
  – glossary of terms
  – links to further information and resources
•    1World  Health Organisation (2009). Fact sheet N315: Chronic obstructive pulmonary disease. Retrieved on
     14/04/2009 from:
•    2Feifer, R., Aubert, R., Verbrugge, R., & Khalid, M. (2002). Disease management

•    opportunities for chronic obstructive pulmonary disease: gaps between guidelines and current practice. [Electronic
     Version] Disease Management, 5 (3), 143-156.
•    3Australian Institute of Health and Welfare (AIHW) (2005). Chronic respiratory diseases in Australia: Their

     prevalence, consequences and prevention. Canberra: AIHW.
•    4Clayton, N. (2007). The effect of COPD on laryngopharyngeal sensitivity and swallow function. Unpublished
     masters thesis, University of Sydney, Sydney, Australia.
•    5Good-Fratturelli, M., Curlee, R., & Holle, J. (2000). Prevalence and nature of dysphagia in VA patients with COPD
     referred for videofluoroscopic swallow examination. [Electronic version] Journal of Communication Disorders, 33,
•    6Gross, R., Atwood, C., Olzewski, J., & Eichorn, K. (2009). The coordination of breathing and swallowing in
     chronic obstructive pulmonary disease. [Electronic version] American Journal of Respiratory and Critical Care
     Medicine, 179, 559-565.
•    7Cvejic, L. (2006). Prevalence of laryngeal penetration and aspiration associated with

•    swallowing in individuals with chronic obstructive pulmonary disease (COPD) [Dissertation]. Faculty of Medicine,
     Nursing & Health Sciences, Monash University: Melbourne.
•    8Martin-Harris, B. (2000). Optimal patterns of care in patients with chronic obstructive

•    pulmonary disease. Seminars in Speech and Language, 21(4), 311-321.
•    9Charmers, J.M., King, P.L., Spencer, A.J., Wright, F.A.C., & Carter, K.D. (2005). The oral health assessment tool
     –validity and reliability. Australian Dental Journal, 50(3), 191-199.
•    10Foulsum, M. (2002). Oral Health Screening Instruction Book (OHST). Bethlehem

•    Hospital, Melbourne.
•    11Kempainen, R. R., Savik, K., Whelan, T. P., Dunitz, J. M, Herrington, C. S., & Billings, J. L. (2007). High

     prevalence of proximal and distal gastroesophageal reflux disease in advanced COPD. [Electronic version]. Chest,
     131(6), 1666-1671
•    12Mokhlesi, B., Morris, A., Huang, C., Curcio, A., Barrett, T. & Kamp, D. (2001). Increased prevalence of
     gastroesophageal reflux symptoms in patients with COPD. Chest. 119(4):1043-8.
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