@article {Cvejic00735-2020, author = {Lydia Cvejic and Nadine Guiney and Tiffany Nicholson and Kenneth K Lau and Paul Finlay and Kais Hamza and Christian Osadnik and Paul Leong and Martin MacDonald and Paul T King and Philip G Bardin}, title = {Aspiration and severe exacerbations in copd: a prospective study}, elocation-id = {00735-2020}, year = {2020}, doi = {10.1183/23120541.00735-2020}, publisher = {European Respiratory Society}, abstract = {Rationale Swallow may be compromised in chronic obstructive pulmonary disease (COPD) leading to aspiration and adverse respiratory consequences. However, prevalence and consequences of detectable aspiration in stable COPD are not known.Objectives We tested the hypothesis that a significant number of patients with stable COPD will have detectable aspiration during swallow (prandial aspiration) and that they would experience more frequent severe acute exacerbations of COPD (AECOPD) over the subsequent 12 months.Methods Patients (n=151) with verified and stable COPD of all severities were recruited at a tertiary care hospital. Videofluoroscopy was conducted to evaluate aspiration using Rosenbek{\textquoteright}s scale for penetration-aspiration during 100 mL cup drinking. AECOPD was documented as moderate (antibiotics and/or corticosteroid treatment) or severe (Emergency Department admission or hospitalisation) over the ensuing 12 months.Measurements and Main Results Aspiration was observed in 30/151 patients (19.9\%, 18 males, 12 females; mean age 72.4 years). Patients with aspiration had more overall AECOPD events (3.03 versus 2 per patient; p=0.022) and severe AECOPD episodes (0.87 versus 0.39; p=0.032). Severe AECOPD occurred in more patients with aspiration (50\% of patients versus 18.2\%; OR=4.5; CI 1.9{\textendash}10.5; p=0.001) and with silent aspiration (36.7\% versus 18.2\%; OR=2.6; CI 1.1{\textendash}6.2; p=0.045). Aspiration was related to a shorter exacerbation-free period during the 12-month follow-up period (p=0.038).Conclusions Prandial aspiration is detectable in a subset of patients with COPD and was predictive of subsequent severe AECOPD. Studies to examine if the association is causal are essential to direct strategies aimed at prevention of aspiration and AECOPD.FootnotesThis manuscript has recently been accepted for publication in the ERJ Open Research. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJOR online. Please open or download the PDF to view this article.Conflict of interest: Ms Cvejic has nothing to disclose.Conflict of interest: N. GUINEY has nothing to disclose.Conflict of interest: Ms Nicholson has nothing to disclose.Conflict of interest: Dr. Lau has nothing to disclose.Conflict of interest: Dr. Finlay has nothing to disclose.Conflict of interest: Dr. Hamza has nothing to disclose.Conflict of interest: Dr. Osadnik reports they were the recipient of a Lung Foundation Australia COPD Research Fellowship (2016{\textendash}2018; AUD$160 000) and is the recipient of a Rebecca L Cooper Medical Research Foundation Project Grant (2020{\textendash}2021; AUD$100 000).Conflict of interest: Dr. Leong is supported by the National Health and Medical Research Council Postgraduate Scholarship and the Royal Australasian College of Physicians, outside of this work. Views expressed do not necessarily reflect those of the funding bodies.Conflict of interest: Dr. MacDonald has nothing to disclose.Conflict of interest: Dr. King has nothing to disclose.Conflict of interest: Dr. Bardin has nothing to disclose.}, URL = {https://openres.ersjournals.com/content/early/2020/10/22/23120541.00735-2020}, eprint = {https://openres.ersjournals.com/content/early/2020/10/22/23120541.00735-2020.full.pdf}, journal = {ERJ Open Research} }