Correlação entre estado nutricional e disfagia em pacientes com doença pulmonar obstrutiva crônica

Abstract

The chronic obstructive pulmonary disease (COPD) is a preventable and treatable common disease, characterized by persistent respiratory symptoms and airflow limitation. Abnormalities in respiratory and ventilatory standards can interfere in deglutition and respiratory coordination in patients with COPD. The decrease in the functional capacity and malnutrition are related to dysphagia, because the protein-caloric malnutrition can indirectly affect the ability of swallowing as a result of muscle depletion and nervous dysfunction. The purpose of this study was to verify the association between the nutritional state and dysphagia among a group of patients with COPD. It is a transversal study involving patients with clinical and spirometric diagnosis of COPD, submitted to the pulmonary rehabilitation program of Hospital Universitário de Santa Maria, RS. The patients were submitted to nutritional evaluation (body mass with anthropometry and electrical bio impedance- BIA, and muscle strength by hand grip strength) and speech-language pathology evaluation (by Volume-Viscosity Swallow Test V-VST protocol, for swallowing clinical evaluation, and video fluoroscopy of swallowing – VFD, to characterize the swallowing bio mechanics) The analysis of the exams was conducted by three judges that were “blinded” in relation to the research objectives, being used to evaluate the visual-space and temporal parameters. 20 patients were studied (11 males and 9 females) with average age between 64 years old (± 9, 13). According to body mass index, we verified more frequency of obesity among women, and more malnutrition and eutrophy among men. The palm pressure strength showed itself reduced in all the patients, however only three presented body mass decrease with electric bio-impedance and by anthropometry. The V-VST test diagnosed dysphagia in 6 patients and VFD in three, and in of them the V-VST was normal and in only one there was lean body bass depletion by BIA. In terms of measurable data of swallowing biomechanics it has been observed that: the oral transit time for the liquid consistency was altered in 15 patients, and for the pasty consistency, in all of them; the pharynx transit time, for both liquid and pasty, was high in all patients; and the number of swallowing remained within normality for these consistencies. When correlated the early subsequent escape values with the lean body mass index evaluated by BIA, it was proven in significant way that the patients with lean body mass depletion were those that presented the higher values in the liquid consistency. This study showed a high prevalence in muscular strength reduction in patients with COPD and one correlation of that with swallowing biomechanical alterations.