Optimal patterns of care in patients with chronic obstructive pulmonary disease.

An intimate relationship exists between the physiological processes of respiration and swallowing at all levels of neuromotor control and peripheral function in healthy adults. Little is known regarding the potential alterations in these patterns in patients with chronic obstructive pulmonary disease (COPD), yet the impact of swallowing impairment and aspiration on the health outcomes of patients with COPD may be significant. COPD is a common comorbidity in patients with head and neck cancer and neurological disorders seen by swallowing clinicians, and warrants consideration during swallowing treatment. This article summarizes reports of alterations in the nutritional status, airway protective mechanisms, and swallowing efficiency that potentially contribute to or exacerbate the chronic and debilitating pulmonary condition. Care guidelines are given for modification of eating and swallowing behavior to optimize the health status of the patient with COPD. The need for controlled clinical trials for validation of the impact of these care guidelines on clinical outcomes is explained.