**Dysphagia in Chronic Obstructive Pulmonary Disease**

Livia Scelza, Catiuscia S.S. Greco, Agnaldo J. Lopes and Pedro Lopes de Melo

Additional information is available at the end of the chapter

**1. Introduction**

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Swallowing is an array of synergistic interdependent movements initiated by complex set of sensory inputs that generate pressures and forces to propel ingested materials through the upper aerodigestive tract and simultaneously protect the upper airway. As seen in Figure 1, the oropharynx is common to both the swallowing and respiratory processes. This functional conflict, therefore, must require fine coordination at the neuronal level to ensure that the peripheral structures produce the intended target behaviour [1].

**Figure 1.** Simplified view of the structures related to swallowing and breathing. Note that the oropharynx is common to both the swallowing and respiratory processes.

Swallowing and breathing are closely related, and synergy of structures is needed for airway protection during the swallowing process to prevent the aspiration of food contents and thus prevent pulmonary complications. The swallowing apnea is described as an important

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mechanism of airway protection. This may be altered in patients who have lung diseases such as chronic obstructive pulmonary disease (COPD) [2, 3]. COPD is a preventable and treatable disease characterized by progressive limitation of airflow that is usually associated with an abnormal inflammatory response of the lungs to noxious particles and gases [4, 5]. COPD is a major public health problem with high and increasing prevalence [4]. According to World Health Organization (WHO) estimates, 80 million people have moderate to severe COPD [6]. Pulmonary changes can be a detrimental factor to coordination between breathing and swallowing [2, 3, 7, 8]. Swallowing apnea requires a reorganization of the breathing pattern when swallowing. This can be limited by the typical respiratory changes observed in patients with COPD [9].

This chapter discusses the history and current state of our knowledge concerning dysphagia in chronic obstructive pulmonary disease. We also describe the development of instrumenta‐ tion for the analysis of the swallowing apnea and preliminary results of this analysis in individuals with COPD. The main topics covered by this review will be as follows:

