An exploratory aerodigestive swallowing study in the chronic respiratory disease, Idiopathic Pulmonary Fibrosis

Abstract

Introduction: Dysphagia occurs in various respiratory conditions, leading to an elevated risk of pulmonary complications due to aspiration. In Idiopathic Pulmonary Fibrosis (IPF), reflux-associated aspiration and dysregulated lung microbiome are implicated in the disease pathophysiology, but there is limited research on swallowing dysfunction in IPF. Aim: The overall aim of this research project is to explore swallowing in patients diagnosed with IPF including perceived changes in their ability to eat and drink. Methods and results: Four studies were conducted using different research designs. The first study aimed to describe the perception of swallowing and oropharyngeal swallowing physiology and safety using the ten-item Eating Assessment Tool (EAT10) and the Videofluoroscopy Swallow Study (VFSS) (n:10). The results showed an increased self-reporting of dysphagia symptoms and a range of swallowing dysfunction, including aspiration into an unprotected airway. The second study assessed swallowing safety and performance using the Water Swallow Test (WST) (n:33). The study identified signs of penetration and/or aspiration and indicated that swallow performance may be influenced by gender and age. IPF patients demonstrated lower swallow performance compared with age- and sex-matched individuals without dysphagia. The WST can be conducted online effectively in community and hospital clinics. The third study described IPF patients’ perceptions of swallowing dysfunction, laryngopharyngeal reflux and laryngeal hypersensitivity symptoms using three validated questionnaires: EAT-10, Reflux Symptoms Index (RSI), and Newcastle Laryngeal Hypersensitivity Questionnaire (LHQ) (n:40). The study revealed that a considerable proportion of patients experience symptoms like swallowing difficulties, laryngopharyngeal reflux and discomfort in the larynx. The fourth study explored the lived eating and drinking experience for IPF patients using qualitative interviews (n:14). The interviews highlighted those patients who experienced eating and drinking changes impacting them physically, emotionally and socially. They employed various coping strategies and expressed a strong desire for knowledge about these changes in their lived experiences. Conclusion: Swallowing dysfunction is a prevalent issue among patients diagnosed with IPF.