COPD and Dysphagia, a 2-Year Follow-up of the Prospective TIE-Cohort Study.

Abstract

Background: Swallowing dysfunction (dysphagia) is increasingly recognised in chronic obstructive pulmonary disease (COPD) and has been associated with aspiration, exacerbations, and impaired health status. However, longitudinal data on dysphagia in COPD are limited.

Aim: To investigate the 2-year stability of self-perceived dysphagia in a COPD cohort and to identify factors associated with persistent dysphagia.

Methods: This prospective cohort study included 438 patients with spirometry-confirmed COPD from the Swedish Tools for Identifying Exacerbations (TIE) study. Self-reported swallowing symptoms were assessed at baseline and at 2-year follow-up using three questions. Dysphagia was defined as the presence of at least one symptom. Clinical assessments included lung function, dyspnoea (mMRC), health status (CAT), physical performance, body mass index (BMI), and exacerbation history. Dysphagia trajectories over time were analysed.

Results: The prevalence of patient-reported dysphagia remained stable over the 2-year period (32% at baseline vs. 33% at follow-up). Four dysphagia trajectories were identified: no dysphagia (59%), incident dysphagia (8%), remission (8%), and persistent dysphagia (25%). Participants with dysphagia at follow-up had higher dyspnoea and CAT scores, poorer physical performance, higher BMI, and more frequent exacerbations. Persistent dysphagia was associated with a consistently higher symptom burden and poorer functional outcomes over time. In multivariate analysis, CAT ≥10 remained independently associated with dysphagia.

Conclusion: Self-perceived dysphagia affects approximately one-third of individuals with COPD and remains stable over two years. Persistent dysphagia may identifiy a more symptomatic COPD phenotype and warrants clinical attention. These findings support the inclusion of simple swallowing screening in routine COPD follow-up.