Chest
Volume 97, Issue 2, February 1990, Pages 347-352
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Cricopharyngeal Dysfunction in Chronic Obstructive Pulmonary Disease

https://doi.org/10.1378/chest.97.2.347Get rights and content

Dysphagia due to cricopharyngeal dysfunction is well known; however, there have been no previous data indicating an association between cricopharyngeal dysfunction and COPD. After observing marked cricopharyngeal dysfunction with aspiration in three patients who had frequent and severe exacerbations of COPD, we performed pharyngoesophageal examinations with videotaping in another 22 nonrandomized patients. Cineradiography or videofluoroscopic recording with capabilities of slow-motion and freeze-frame playback is mandatory, since the transit time of the bolus through the pharynx is rapid. Severe cricopharyngeal dysfunction was observed in 17 elderly patients with COPD. Deglutition disorders were elicited by careful questioning in 15 of these. In eight subjects, cricopharyngeal myotomy resulted in improvement of swallowing and complete or partial relief of acute exacerbations of respiratory distress. In one subject, myotomy relieved only the swallowing problem. The mechanism of cricopharyngeal dysfunction in elderly patients with COPD is unknown at this time, but may be related to gastroesophageal reflux, therapeutic agents, and/or alterations in pharyngoesophageal anatomic structures. We conclude that investigations for swallowing disorders should be considered in patients with COPD who have frequent acute exacerbations of respiratory distress.

(Chest 1990; 97:347–52)

Section snippets

Protocol

Based on our experience with three patients with severe COPD and clinically overt swallowing difficulties in whom cricopharyngeal dysfunction was verified, we studied an additional 22 patients with severe COPD who were subject to frequent exacerbations. All studies were performed in a community hospital. These studies were neither consecutive nor randomized, but were based upon historical data and the patient's willingness to have pharyngoesophageal studies with videotaping. Clinical historical

CASE REPORTS

A brief description of our index cases may IK* of help in describing this complication or abnormality.

RESULTS

We studied 25 patients with cricopharyngeal dysfunction who had moderate to severe COPD and FEV1 less than 70 percent of predicted (Table 1). All of these patients had been referred for frequent exacerbations of respiratory distress.

Twenty-one of the patients had dysfunction of the cricopharyngeous muscle shown by videotape recordings of the swallowing sequence. All patients studied except one were over the age of 50 years. There was an apparent association between age and severity of

DISCUSSION

Patients with COPD are commonly subject to frequent exacerbations which are assumed to be related to infection or bronchial hyperreactivity. Herein we have identified an additional factor, cricopharyngeal achalasia, in 21 of 25 patients. In 17 of these patients, it was judged to be severe, and in retrospect, all were found to have some degree of symptomatic dysphagia. Surgical correction in ten of them was associated with definite clinical improvement of pulmonary symptoms in eight.

Aspiration

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