Asymptomatic Dysphagia and Aspiration in Patients with Idiopathic Bronchiectasis

• Published in: Lung Vol. 202; no. 2; pp. 189 - 195
• Main Authors: Perluk, Tal, Abu Bandora, Eiman, Freund, Ophir, Jacob, Tommy, Friedman Regev, Inbal, Kleinhendler, Eyal, Shteinberg, Michal, Bar-Shai, Amir, Oestriecher-Kedem, Yael
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-04-2024; Springer Nature B.V
• Subjects: Aged; Aged, 80 and over; Asymptomatic; Bronchiectasis; Bronchiectasis - complications; Bronchiectasis - epidemiology; Deglutition; Deglutition Disorders - diagnosis; Deglutition Disorders - epidemiology; Deglutition Disorders - etiology; Dysphagia; DYSPHAGIA and BRONCHIECTASIS; Dyspnea; Female; Humans; Medicine; Medicine & Public Health; Middle Aged; Parameter identification; Pneumology/Respiratory System; Prospective Studies; Questionnaires; Respiration; Respiratory Aspiration - diagnosis; Respiratory Aspiration - epidemiology; Respiratory Aspiration - etiology; Swallowing; EAT-10 score; Fiberoptic Endoscopic Evaluation of Swallowing; Bronchiectasis; Diagnosis; Aspiration
• ISSN: 0341-2040; 1432-1750
• DOI: 10.1007/s00408-024-00683-5

Purpose
Although considered contributors to idiopathic bronchiectasis (IB), neither dysphagia nor silent aspiration have been systematically evaluated in IB patients. We aimed to explore the prevalence of asymptomatic dysphagia and silent aspiration in IB patients and to identify parameters predictive of their presence.
Methods
This prospective cohort study included IB patients from our Pulmonary Institute without prior history of dysphagia and without prior dysphagia workup. Swallowing function was assessed by the Eating Assessment Tool (EAT-10) questionnaire and by the Fiberoptic Endoscopic Evaluation of Swallowing (FEES) test.
Results
Forty-seven patients (31 females, mean age 67 ± 16 years) were recruited. An EAT-10 score ≥ 3 (risk for swallowing problems) was present in 21 patients (44.6%). Forty-two patients (89.3%) had at least one abnormal swallowing parameter in the FEES test. Six patients (12.7%) had a penetration aspiration score (PAS) in the FEES of at least 6, indicating aspiration. An EAT-10 score of 3 was found to be the ideal cutoff to predict aspiration in the FEES, with a good level of accuracy (area under the curve = 0.78, 95% CI 0.629–0.932,
p
 = 0.03) and sensitivity of 83%. This cutoff also showed a trend towards a more severe disease using the FACED (forced expiratory volume, age, colonization with pseudomonas, extension of lung involvement, dyspnea) score (
p
 = 0.05).
Conclusion
Dysphagia is prevalent in IB and may be undiagnosed if not specifically sought. We recommend screening all patients with IB for dysphagia by the EAT-10 questionnaire and referring all those with a score of ≥ 3 to formal swallowing assessment.