Respiratory Dysphagia

What is dysphagia?

Dysphagia is a disorder of swallowing.
As swallowing and breathing involve some of the same anatomical structures, dysfunction in one may lead to impaired function in the other.

Why is dysphagia a problem?

People with dysphagia are at high risk of food, fluid or their own saliva/ secretions going down the wrong way. This means going into the lungs instead of the stomach. This is known as aspiration. Aspiration can cause chest infections and pneumonia.

How is swallowing linked to breathing?

The normal pattern is:

Breathe out > hold breath to protect airway > swallow > continue to breathe out a little > breathe in and repeat

If you are short of breath, you could breathe in after swallowing rather than breathe out and accidentally inhale food or drink.

Causes of dysphagia with respiratory difficulties

There is a number of reasons why dysphagia might occur with respiratory problems. These include:

• Muscle fatigue and weakness; reduced airway protection; increased need for oxygen; increased respiratory rate; difficulties managing saliva/ secretions.
• Dry mouth (xerostomia) and its associated issues such as problems with taste and changes in secretions.
• The impact of acid reflux (gastro-oesophageal reflux).
• Side effects of medications.

Signs and symptoms of respiratory dysphagia

You could experience some of these:

• Eating and drinking less
• Loss of appetite
• Avoidance of ‘difficult’ foods such as crunchy or dry food or meat
• Taking longer to finish meals
• Sensation of food sticking in the throat
• Increased breathing effort
• Fatigue
• Drop in saturated oxygen levels (SATs) whilst eating or drinking
• Excessive gulping of air
• Anxiety when eating or drinking
• Feeling ‘full-up’ too soon
• Experiencing reflux/ acid
• Coughing (including coughing up secretions)
• Chest infections

Management of respiratory dysphagia

Here are some suggestions that can ease swallowing problems:

• Do not eat or drink if you are feeling too tired or very unwell or if you are much more breathless than usual – wait until later.
• Sit upright as comfortably as you can to eat or drink.
• If you have dentures, make sure they fit properly; if not, try a fixative. Wear them if they are comfortable.
• Use saliva replacement products if your mouth is too dry.
• If you have secretions stuck in your throat or back of the mouth, try to cough and clear these; use any assistive measures you may already have (e.g. cough assist or nebuliser).
• Avoid tipping your head back to swallow.
• Avoid continuous drinking – take single sips instead.
• Do not drink using spouts or straws unless they have been specifically recommended.
• Choose softer, moist foods to avoid excessive chewing. Add extra moisture to meals e.g. sauces, gravy etc.