The relationship between pulmonary and swallowing functions in patients with neuromuscular diseases followed up by a tertiary referral center: a cross-sectional study

Abstract

Introduction

Respiratory muscle weakness is common in patients with neuromuscular diseases (NMD). This puts them at risk for dysphagia and other pulmonary complications.

Objectives

To investigate the relationship between pulmonary function and swallowing in NMD.

Materials and methods

In this cross-sectional study, medical records of patients undergoing treatment at the Tertiary Referral Center for Neuromuscular Diseases of Hospital de Apoio de Brasília, Brazil, were reviewed. Respiratory function was assessed through spirometry (FVC and FEV1 measured) and swallowing assessed by the Dysphagia Risk Evaluation Protocol and the Functional Oral Intake Scale.

Results

Two hundred and twenty-two patients were included. Dysphagia was present in 46.8% of patients and impairment of pulmonary function in 64.0%. The mean FVC observed was 66.9% and FEV1 was 66.0%, indicating restrictive lung disease. A correlation between the decline of pulmonary and swallowing functions was observed in patients with NMDs (FVC vs. DREP, R = 0.46; FVC vs. FOIS, R = 0.42; FEV1 vs. DREP, R = 0.42; FEV1 vs. FOIS, R = 0.40, p<.01). FVC and FEV1 values tend to be lower in patients with dysphagia in the context of NMD.

Conclusions

A positive correlation between pulmonary function and swallowing outcomes was observed in patients with NMD. Despite respiratory and swallowing impairment being widely present in the population with NMD, they require different treatments according to the disease's pathophysiology. Future studies should be conducted to explore the disease-specific relationship between pulmonary function and swallowing in patients with NMD.

Keywords:

• Neuromuscular diseases
• dysphagia
• spirometry
• pulmonary function test
• amyotrophic lateral sclerosis

Acknowledgements

The authors thank Dr. Karen Fontes Luchesi for scientific advice.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Notes on contributors

Max Sarmet

Max Sarmet, MSc, is a senior speech therapist at the Tertiary Referral Center of Neuromuscular diseases of Hospital de Apoio de Brasília (HAB). He obtained the title of Master of Sciences in Medical Sciences at University of Brasilia (UnB) and is currently PhD student at Graduate Department of Health Sciences and Technologies of UnB. His research focuses on neuromuscular diseases, especially concerning swallowing, speech and pulmonary functions. He is currently participating in a clinical trial exploring a new respiratory therapy for patients with ALS.

Laura Davison Mangilli

Laura Davison Mangilli, PhD, is a speech therapist. She obtained the title of Master of Sciences, PhD and Post Doctoral degree from the College of Medicine of Universidade de São Paulo. She is currently an Associate Professor at the Faculdade de Ceilândia, University of Brasília.

Geovanna Pereira Costa

Geovanna Pereira Costa and Juliana Peres Ribeiro Soares Paes are seniors at the Undergraduate Program of the College of Medicine of Escola Superior de Ciências da Saúde (ESCS). This research project was part of their scientific initiation program.

Vitor Martins Codeço

Vitor Martins Codeço is a pulmonologist at the Hospital Regional da Asa Norte (HRAN), responsible for respiratory medical care at the Tertiary Referral Center of Neuromuscular Diseases. He has expertise in sleep medicine, also responsible for the sleep laboratory of HRAN. He is particularly interested in the study of sleep, its respiratory disorders and the use of non-invasive ventilation.

Janae Lyon Million

Janae Lyon Million, MSc, is biologist and a teacher at the American School of Brasília. She obtained her Master’s from the Botany department at UnB, with a focus on the medicinal plants used by the indigenous Kaiowá. Her undergraduate degree is a BS in Human Biology from the University of California, Santa Cruz, (UCSC) USA.

Vinicius Maldaner

Vinicius Maldaner, PhD, is a physical therapist at HAB and Professor at ESCS. He obtained his PhD from the Graduate Department of Health Sciences and Technologies of UnB and The University of New Mexico, USA. Currently, he coordinates several studies on respiratory therapy and neuromuscular diseases. His research focuses on the study of neuromuscular diseases, non-invasive ventilation, lung function, intensive care and functional recovery after hospital discharge.