COPDの嚥下障害：系統的レビュー

これも少し古いですが、COPD患者の嚥下障害の系統的レビューを紹介します。

Lisa O'Kane, Michael Groher. Oropharyngeal dysphagia in patients with chronic obstructive pulmonary disease: a systematic review. Rev. CEFAC vol.11 no.3 São Paulo July/Sept. 2009 Epub Aug 21, 2009

下記のHPで全文見ることができます。

http://www.scielo.br/scielo.php?pid=S1516-18462009000300019&script=sci_arttext

結果ですが、2008年までにCOPDと嚥下で検索すると、47論文がひっかかりましたが、そのうち7論文しかCOPDの嚥下障害について触れていませんでした。ただし、COPD患者は急性増悪の時に嚥下障害を認めやすいようです。均一なCOPD患者で呼吸機能と嚥下機能について調査することが重要という結論です。

COPDの嚥下障害の論文も少ないですが、慢性心不全や慢性腎不全の嚥下障害の論文はもっと少ないです。これらを比較することで、どこまでが呼吸と嚥下の関連の問題か、どこまでがサルコペニアの嚥下障害の問題かをより明確にできるのではないかと感じます。今後の研究課題ですね。

ABSTRACT
BACKGROUND: oropharyngeal dysphagia in patients with chronic obstructive pulmonary disease.
PURPOSE: patients with Chronic Obstructive Pulmonary Disease (COPD) can be vulnerable to respiratory incompetence that may lead to swallowing impairment. A systematic review was conducted to investigate the relationship between Chronic Obstructive Pulmonary Disease and oropharyngeal dysphagia. Forty-seven articles were retrieved relating to Chronic Obstructive Pulmonary Disease and dysphagia. Each article was graded using evidence-based methodology. Only 7 articles out of the 47 addressed oropharyngeal swallowing disorders in patients with Chronic Obstructive Pulmonary Disease. This review found few studies that documented the relationship between oropharyngeal swallowing disorders and Chronic Obstructive Pulmonary Disease. There were no randomized control trials.
CONCLUSION: although the evidence is not strong, it appears that patients with Chronic Obstructive Pulmonary Disease are prone to oropharyngeal dysphagia during exacerbations. Future studies are needed to document the prevalence of oropharyngeal dysphagia in homogeneous groups of patients with Chronic Obstructive Pulmonary Disease, and to assess the relationship between respiration and swallowing using simultaneous measures of swallowing biomechanics and respiratory function. These investigations will lead to a better understanding of the characteristics and risk factors of developing oropharyngeal dypshagia in patients with Chronic Obstructive Pulmonary Disease.