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Aspiration and severe exacerbations in COPD: a prospective study

Lydia Cvejic, Nadine Guiney, Tiffany Nicholson, Kenneth K. Lau, Paul Finlay, Kais Hamza, Christian Osadnik, Paul Leong, Martin MacDonald, Paul T. King, Philip G. Bardin
ERJ Open Research 2021 7: 00735-2020; DOI: 10.1183/23120541.00735-2020
Lydia Cvejic
1Monash Lung and Sleep, Monash Health, Melbourne, Australia
2School of Clinical Sciences, Monash University, Melbourne, Australia
3Hudson Institute and Monash University, Melbourne, Australia
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Nadine Guiney
1Monash Lung and Sleep, Monash Health, Melbourne, Australia
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Tiffany Nicholson
4Diagnostic Imaging, Monash Health, Melbourne, Australia
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Kenneth K. Lau
2School of Clinical Sciences, Monash University, Melbourne, Australia
4Diagnostic Imaging, Monash Health, Melbourne, Australia
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  • ORCID record for Kenneth K. Lau
Paul Finlay
1Monash Lung and Sleep, Monash Health, Melbourne, Australia
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Kais Hamza
5School of Mathematical Sciences, Monash University, Melbourne, Australia
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Christian Osadnik
1Monash Lung and Sleep, Monash Health, Melbourne, Australia
3Hudson Institute and Monash University, Melbourne, Australia
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  • ORCID record for Christian Osadnik
Paul Leong
1Monash Lung and Sleep, Monash Health, Melbourne, Australia
2School of Clinical Sciences, Monash University, Melbourne, Australia
3Hudson Institute and Monash University, Melbourne, Australia
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Martin MacDonald
1Monash Lung and Sleep, Monash Health, Melbourne, Australia
2School of Clinical Sciences, Monash University, Melbourne, Australia
3Hudson Institute and Monash University, Melbourne, Australia
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Paul T. King
1Monash Lung and Sleep, Monash Health, Melbourne, Australia
2School of Clinical Sciences, Monash University, Melbourne, Australia
3Hudson Institute and Monash University, Melbourne, Australia
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Philip G. Bardin
1Monash Lung and Sleep, Monash Health, Melbourne, Australia
2School of Clinical Sciences, Monash University, Melbourne, Australia
3Hudson Institute and Monash University, Melbourne, Australia
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  • For correspondence: philip.bardin@monash.edu
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  • FIGURE 1
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    FIGURE 1

    Consort diagram of patient participation in the study. ED: emergency department.

  • FIGURE 2
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    FIGURE 2

    a) Aspiration was associated with severe episodes of acute exacerbations of COPD (AECOPD). Left panel: severe AECOPD events were more frequent in patients with aspiration (ratio 0.87; n=30) than if no aspiration (ratio 0.39; n=121). Right panel: number (%) of patients with at least one severe episode was greater in patients with aspiration (50%) than if no aspiration (18%). (-): aspiration not detected; (+): aspiration detected. b) Kaplan–Meier analysis of patients with no aspiration (open diamonds) and aspiration (closed diamonds) who were exacerbation-free over 12 months of follow-up. Difference between groups analysed using log-rank testing.

  • FIGURE 3
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    FIGURE 3

    Subgroup analyses of history and types of acute exacerbations of COPD (AECOPD) associated with aspiration or no aspiration. Prior: 12 months prior to study; Current: 12 months of current study.

Tables

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  • TABLE 1

    Baseline characteristics of 151 patients enrolled in studies of aspiration in COPD

    Aspiration not detectedAspiration# detected
    Subjects n12130
    Age years (range)70.2±5.1 (60.1–80.6)72.4±4.3¶ (65.7–78.8)
    Male/female74/4718/12
    Body mass index kg·m−229.4±5.827.7±6.4
    FEV1 % predicted49.2±15.345.3±15.3
    FEV1/FVC ratio %53.1±13.951.0±11.1
    TLC % predicted129.2±22.0129.0±20.5
    RV/TLC %58.4±8.860.5±8.2
    FENO ppb24.5±23.822.4±22.1
    SpO2 %95.3±1.894.7±2.8
    Respiratory rate breaths·min−117.9±4.018.7±4.7
    Comorbidities
     Cardiovascular disease99 (82)28 (93)
     Chronic kidney disease7 (6)1 (3)
     Gastro-oesophageal reflux disease72 (60)17 (57)
     Obstructive sleep apnoea20 (17)3 (10)
     Diabetes18 (15)7 (23)
     Anxiety–depression27 (22)8 (27)
    Medication
     ICS/LABA only15 (12)2 (7)
     ICS/LABA/LAMA94 (78)27 (90)
     Systemic corticosteroids (long term)36 (30)12 (40)
     Antibiotics (long term)28 (23)7 (23)
     Oxygen therapy21 (17)7 (23)
     Influenza vaccination41 (34)11 (37)
     Pneumococcal vaccination11 (9)4 (13)
     Antihypertensives96 (79)26 (87)
     Antianxiety/antidepressant47 (39)13 (43)
     Angiotensin-converting enzyme inhibitors26 (22)7 (23)
     Reflux medications79 (65)17 (57)
    AQ20 score9.6±4.210.9±3.9
    AQ20 score >879 (65)23 (77)
    EAT-10 score2.3±3.92.9±4.6
    OHAT score2.2±2.13.1±2.7
    Resting saliva pH6.5±0.56.4±0.7

    Data are presented as mean±sd or n (%), unless otherwise indicated. FEV1: forced expiratory volume in 1 s; FVC: forced vital capacity; TLC: total lung capacity; RV: residual volume; FENO: exhaled nitric oxide fraction; SpO2: oxygen saturation measured by pulse oximetry; ICS: inhaled corticosteroids; LABA: long-acting beta agonists; LAMA: long-acting muscarinic antagonist; AQ20: Airways Questionnaire-20; EAT-10: Eating Assessment Tool; OHAT: Oral Health Assessment Tool. #: aspiration score of 6–8 on the penetration–aspiration scale [2]; ¶: p≤0.02.

    Supplementary Materials

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    • Supplementary Material

      Please note: supplementary material is not edited by the Editorial Office, and is uploaded as it has been supplied by the author.

      Supplementary material 00735-2020.SUPPLEMENT

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    Aspiration and severe exacerbations in COPD: a prospective study
    Lydia Cvejic, Nadine Guiney, Tiffany Nicholson, Kenneth K. Lau, Paul Finlay, Kais Hamza, Christian Osadnik, Paul Leong, Martin MacDonald, Paul T. King, Philip G. Bardin
    ERJ Open Research Jan 2021, 7 (1) 00735-2020; DOI: 10.1183/23120541.00735-2020

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    Aspiration and severe exacerbations in COPD: a prospective study
    Lydia Cvejic, Nadine Guiney, Tiffany Nicholson, Kenneth K. Lau, Paul Finlay, Kais Hamza, Christian Osadnik, Paul Leong, Martin MacDonald, Paul T. King, Philip G. Bardin
    ERJ Open Research Jan 2021, 7 (1) 00735-2020; DOI: 10.1183/23120541.00735-2020
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