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The Mind–Body–Breath Link During Oral Intake in Chronic Obstructive Pulmonary Disease: A Grounded Theory Analysis

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Abstract

Both chronic obstructive pulmonary disease (COPD) and dysphagia can be complicated by the shared physiological-psychoemotional manifestations of the conditions, such as anxiety and respiratory dysfunction. Despite their shared comorbidities, clinical research and management often focus on the isolated physiological impairments of each condition separately. Crucially, the oral intake experience of individuals with COPD—central for improved quality of life—remains underexplored. Thus, the purpose of this study was to understand the oral intake experience among individuals with COPD, including perceived barriers, behaviors, and emotions. Fourteen individuals with COPD (mean age 68.9; 7 females; 2 with diagnosed dysphagia) participated. Using grounded theory methodology, semi-structured interviews were conducted and analyzed. Four themes surfaced: (a) participants experience physiological manifestations of COPD (dyspnea, coughing) during eating/drinking; (b) emotions related to eating/drinking, such as concern, fear, anxiety, panic, and frustration stem from the physiological manifestations; (c) these emotions worsen the physiological manifestations; and (d) as a result of the physiological manifestations, they adapt eating/drinking behaviors (e.g., choose easier to eat foods, reduce intake size). The theory ‘the mind–body–breath feedback and feedforward loops as a contributor to the oral intake experience in individuals with COPD’ is subsequently proposed. Of clinical importance, many participants did not recognize their swallowing status as an issue. Ultimately, to promote patient-centered care, we need to view the oral intake experience for individuals with COPD through a more comprehensive lens that incorporates the interrelationships between the physiological and psychoemotional manifestations of COPD and better educate patients on COPD’s impact on eating and drinking.

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References

  1. Mathers CD, Loncar D. Projections of global mortality and burden of disease from 2002 to 2030. PLoS Med. 2006;3: e442. https://doi.org/10.1371/journal.pmed.0030442.

    Article  Google Scholar 

  2. Ford ES, Murphy LB, Khavjou O, Giles WH, Holt JB, Croft JB. Total and state-specific medical and absenteeism costs of COPD among adults aged 18 years in the United States for 2010 and projections through 2020. Chest. 2015;147:31–45. https://doi.org/10.1378/chest.14-0972.

    Article  Google Scholar 

  3. Cvejic L, Bardin PG. Swallow and aspiration in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2018. https://doi.org/10.1164/rccm.201804-0704PP.

    Article  Google Scholar 

  4. Gross RD, Prigent H. Chronic obstructive pulmonary disease and occult aspiration: a review of the recent literature. Curr Phys Med Rehabil Rep. 2015;3:280–6. https://doi.org/10.1007/s40141-015-0102-5.

    Article  Google Scholar 

  5. Good-Fratturelli MD, Curlee RF, Holle JL. Prevalence and nature of dysphagia in VA patients with COPD referred for videofluoroscopic swallow examination. J Commun Disord. 2000;33:93–110. https://doi.org/10.1016/S0021-9924(99)00026-X.

    Article  CAS  Google Scholar 

  6. World Health Organization. Chronic obstructive pulmonary disease (COPD). In: Chronic obstructive pulmonary disease COPD. WHO; 2021. https://www.who.int/news-room/fact-sheets/detail/chronic-obstructive-pulmonary-disease-(copd).

  7. Parshall MB, Schwartzstein RM, Adams L, Banzett RB, Manning HL, Bourbeau J, Calverley PM, Gift AG, Harver A, Lareau SC, Mahler DA, Meek PM, O’Donnell DE. An Official American Thoracic Society Statement: update on the mechanisms, assessment, and management of dyspnea. Am J Respir Crit Care Med. 2012;185:435–52. https://doi.org/10.1164/rccm.201111-2042ST.

    Article  Google Scholar 

  8. O’Donnell DE, Banzett RB, Carrieri-Kohlman V, Casaburi R, Davenport PW, Gandevia SC, Gelb AF, Mahler DA, Webb KA. Pathophysiology of dyspnea in chronic obstructive pulmonary disease: a roundtable. Proc Am Thorac Soc. 2007;4:145–68. https://doi.org/10.1513/pats.200611-159CC.

    Article  Google Scholar 

  9. Hynninen KMJ, Breitve MH, Wiborg AB, Pallesen S, Nordhus IH. Psychological characteristics of patients with chronic obstructive pulmonary disease: a review. J Psychosom Res. 2005;59:429–43. https://doi.org/10.1016/j.jpsychores.2005.04.007.

    Article  Google Scholar 

  10. Pooler A, Beech R. Examining the relationship between anxiety and depression and exacerbations of COPD which result in hospital admission: a systematic review. Int J Chronic Obstr Pulm Dis. 2014. https://doi.org/10.2147/COPD.S53255.

    Article  Google Scholar 

  11. Singh G, Zhang W, Kuo Y-F, Sharma G. Association of psychological disorders with 30-day readmission rates in patients with COPD. Chest. 2016;149:905–15. https://doi.org/10.1378/chest.15-0449.

    Article  Google Scholar 

  12. O’Kane L, Groher M. Oropharyngeal dysphagia in patients with chronic obstructive pulmonary disease: a systematic review. Rev CEFAC. 2009;11:449–506.

    Google Scholar 

  13. Mancopes R, Peladeau-Pigeon M, Barrett E, Guran A, Smaoui S, Pasqualoto AS, Steele CM. Quantitative videofluoroscopic analysis of swallowing physiology and function in individuals with chronic obstructive pulmonary disease. J Speech Lang Hear Res. 2020;63:3643–58. https://doi.org/10.1044/2020_JSLHR-20-00154.

    Article  Google Scholar 

  14. Santos JMLG, et al. Interventions to prevent aspiration pneumonia in older adults: an updated systematic review. J Speech Lang Hear Res. 2021;64(2):1–17.

    Google Scholar 

  15. Shaker R, Li Q, Ren J, Townsend WF, Dodds WJ, Martin BJ, Kern MK, Rynders A. Coordination of deglutition and phases of respiration: effect of aging, tachypnea, bolus volume, and chronic obstructive pulmonary disease. Am J Physiol Gastrointest Liver Physiol. 1992;263:G750–5. https://doi.org/10.1152/ajpgi.1992.263.5.G750.

    Article  CAS  Google Scholar 

  16. Gross RD, Atwood CW, Ross SB, Olszewski JW, Eichhorn KA. The coordination of breathing and swallowing in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2009;179:559–65. https://doi.org/10.1164/rccm.200807-1139OC.

    Article  Google Scholar 

  17. Cvejic L, Harding R, Churchward T, Turton A, Finlay P, Massey D, Bardin PG, Guy P. Laryngeal penetration and aspiration in individuals with stable COPD: aspiration in COPD. Respirology. 2011;16:269–75. https://doi.org/10.1111/j.1440-1843.2010.01875.x.

    Article  Google Scholar 

  18. Martin-Harris B, Brodsky MB, Michel Y, Ford CL, Walters B, Heffner J. Breathing and swallowing dynamics across the adult lifespan. Arch Otolaryngol Neck Surg. 2005;131:762–70.

    Google Scholar 

  19. Steidl E, Ribeiro C, Gonçalves B, Fernandes N, Antunes V, Mancopes R. Relationship between dysphagia and exacerbations in chronic obstructive pulmonary disease: a literature review. Int Arch Otorhinolaryngol. 2014;19:074–9. https://doi.org/10.1055/s-0034-1376430.

    Article  Google Scholar 

  20. Kobayashi S, Kubo H, Yanai M. Impairment of the swallowing reflex in exacerbations of COPD. Thorax. 2007;62:1017–1017. https://doi.org/10.1136/thx.2007.084715.

    Article  Google Scholar 

  21. Terada K, Muro S, Ohara T, Kudo M, Ogawa E, Hoshino Y, Hirai T, Niimi A, Chin K, Mishima M. Abnormal swallowing reflex and COPD exacerbations. Chest. 2010;137:326–32. https://doi.org/10.1378/chest.09-0482.

    Article  Google Scholar 

  22. Drulia T. The effects of lung volume on swallowing in chronic obstructive pulmonary disease. PhD Dissertation, Department of Communication Sciences and Disorders, James Madison University; 2016.

  23. Hoit J, Lansing R, Dean K, Yarkosky M, Lederle A. Nature and evaluation of dyspnea in speaking and swallowing. Semin Speech Lang. 2011;32:005–20. https://doi.org/10.1055/s-0031-1271971.

    Article  Google Scholar 

  24. Eslick GD, Talley NJ. Dysphagia: epidemiology, risk factors and impact on quality of life—a population-based study: DYSPHAGIA - A POPULATION-BASED STUDY. Aliment Pharmacol Ther. 2008;27:971–9. https://doi.org/10.1111/j.1365-2036.2008.03664.x.

    Article  CAS  Google Scholar 

  25. Baijens LWJ, Koetsenruijter K, Pilz W. Diagnosis and treatment of phagophobia: a review. Dysphagia. 2013;28:260–70. https://doi.org/10.1007/s00455-013-9454-0.

    Article  Google Scholar 

  26. Martino R, Beaton D, Diamant NE. Perceptions of psychological issues related to dysphagia differ in acute and chronic patients. Dysphagia. 2010;25:26–34. https://doi.org/10.1007/s00455-009-9225-0.

    Article  Google Scholar 

  27. Ekberg O, Hamdy S, Woisard V, Wuttge-Hannig A, Ortega P. Social and psychological burden of dysphagia: its impact on diagnosis and treatment. Dysphagia. 2002;17:139–46. https://doi.org/10.1007/s00455-001-0113-5.

    Article  Google Scholar 

  28. Lisiecka D, Kelly H, Jackson J. How do people with Motor Neurone Disease experience dysphagia? A qualitative investigation of personal experiences. Disabil Rehabil. 2019. https://doi.org/10.1080/09638288.2019.1630487.

    Article  Google Scholar 

  29. Howells SR, Cornwell PL, Ward EC, Kuipers P. Client perspectives on living with dysphagia in the community. Int J Speech Lang Pathol. 2020. https://doi.org/10.1080/17549507.2020.1765020.

    Article  Google Scholar 

  30. Plastow NA, Atwal A, Gilhooly M. Food activities and identity maintenance in old age: a systematic review and meta-synthesis. Aging Ment Health. 2015;19:667–78. https://doi.org/10.1080/13607863.2014.971707.

    Article  Google Scholar 

  31. Klinke ME, Wilson ME, Hafsteinsdóttir TB, Jónsdóttir H. Recognizing new perspectives in eating difficulties following stroke: a concept analysis. Disabil Rehabil. 2013;35:1491–500. https://doi.org/10.3109/09638288.2012.736012.

    Article  Google Scholar 

  32. Verdonschot RJCG, Baijens LWJ, Vanbelle S, van de Kolk I, Kremer B, Leue C. Affective symptoms in patients with oropharyngeal dysphagia: a systematic review. J Psychosom Res. 2017;97:102–10. https://doi.org/10.1016/j.jpsychores.2017.04.006.

    Article  Google Scholar 

  33. Verdonschot RJCG, Baijens LWJ, Serroyen JL, Leue C, Kremer B. Symptoms of anxiety and depression assessed with the Hospital Anxiety and Depression Scale in patients with oropharyngeal dysphagia. J Psychosom Res. 2013;75:451–5. https://doi.org/10.1016/j.jpsychores.2013.08.021.

    Article  Google Scholar 

  34. Patterson JM, McColl E, Carding PN, Hildreth AJ, Kelly C, Wilson JA. Swallowing in the first year after chemoradiotherapy for head and neck cancer: clinician- and patient-reported outcomes: swallowing outcomes after chemoradiotherapy for head and neck cancer. Head Neck. 2014;36:352–8. https://doi.org/10.1002/hed.23306.

    Article  Google Scholar 

  35. Krebbers I, Simon SR, Pilz W, Kremer B, Winkens B, Baijens LWJ. Patients with head-and-neck cancer: dysphagia and affective symptoms. Folia Phoniatr Logop. 2020. https://doi.org/10.1159/000508367.

    Article  Google Scholar 

  36. Drulia TC, Kamarunas E, O’Donoghue C, Ludlow CL. An exploration of lung volume effects on swallowing in chronic obstructive pulmonary disease. Am J Speech Lang Pathol. 2021;30:2155–68. https://doi.org/10.1044/2021_AJSLP-20-00389.

    Article  Google Scholar 

  37. Lin T, Shune S. Chronic obstructive pulmonary disease and dysphagia: a synergistic review. Geriatrics. 2020;5:45. https://doi.org/10.3390/geriatrics5030045.

    Article  Google Scholar 

  38. Charmaz K. Constructing grounded theory. 2nd ed. Thousand Oaks: Sage Publications; 2014.

    Google Scholar 

  39. Wu YP, Thompson D, Aroian KJ, McQuaid EL, Deatrick JA. Commentary: writing and evaluating qualitative research reports. J Pediatr Psychol. 2016;41:493–505. https://doi.org/10.1093/jpepsy/jsw032.

    Article  Google Scholar 

  40. Saldaña J. The coding manual for qualitative researchers. London: Sage; 2016.

    Google Scholar 

  41. Dey I. Grounding grounded theory. San Francisco: Academic; 1999.

    Google Scholar 

  42. Creswell J. Qualitative inquiry and research design: choosing among five traditions. Thousand Oaks: Sage; 2018.

    Google Scholar 

  43. Dudley DL, Glaser EM, Jorgenson BN, Logan DL. Psychosocial concomitants to rehabilitation in chronic obstructive pulmonary disease Pt. 1. Chest. 1980;77:413–20. https://doi.org/10.1378/chest.77.3.413.

    Article  CAS  Google Scholar 

  44. Lederle A, Hoit JD, Barkmeier-Kraemer J. Effects of sequential swallowing on drive to breathe in young, healthy adults. Dysphagia. 2012;27:221–7. https://doi.org/10.1007/s00455-011-9357-x.

    Article  Google Scholar 

  45. Garand KL, Strange C, Paoletti L, Hopkins-Rossabi T, Martin-Harris B. Oropharyngeal swallow physiology and swallowing-related quality of life in underweight patients with concomitant advanced chronic obstructive pulmonary disease. Int J Chronic Obstr Pulm Dis. 2018;13:2663–71. https://doi.org/10.2147/COPD.S165657.

    Article  Google Scholar 

  46. Philippot P, Chapelle G, Blairy S. Respiratory feedback in the generation of emotion. Cogn Emot. 2002;16:605–27. https://doi.org/10.1080/02699930143000392.

    Article  Google Scholar 

  47. von Leupoldt A, Taube K, Henkhus M, Dahme B, Magnussen H. The impact of affective states on the perception of dyspnea in patients with chronic obstructive pulmonary disease. Biol Psychol. 2010;84:129–34. https://doi.org/10.1016/j.biopsycho.2009.07.010.

    Article  Google Scholar 

  48. Stein M, Williams AJ, Grossman F, Weinberg AS, Zuckerbraun L. Cricopharyngeal dysfunction in chronic obstructive pulmonary disease. Chest. 1990;97:347–52.

    CAS  Google Scholar 

  49. Livermore N, Dimitri A, Sharpe L, McKenzie DK, Gandevia SC, Butler JE. Cognitive behaviour therapy reduces dyspnoea ratings in patients with chronic obstructive pulmonary disease (COPD). Respir Physiol Neurobiol. 2015;216:35–42. https://doi.org/10.1016/j.resp.2015.05.013.

    Article  Google Scholar 

  50. Thompson SC. Will it hurt less if I can control it? A complex answer to a simple question. Psychol Bull. 1981;90:89.

    CAS  Google Scholar 

  51. Carrieri-Kohlman V, Gormley JM, Douglas MK, Paul SM, Stulbarg MS. Differentiation between dyspnea and its affective components. West J Nurs Res. 1996;18:626–42. https://doi.org/10.1177/019394599601800602.

    Article  CAS  Google Scholar 

  52. World Health Organization. Constitution. WHO; 2020. https://www.who.int/about/who-we-are/constitution.

  53. Rathert C, Wyrwich MD, Boren SA. Patient-centered care and outcomes: a systematic review of the literature. Med Care Res Rev. 2013;70:351–79. https://doi.org/10.1177/1077558712465774.

    Article  Google Scholar 

  54. World Health Organization. International classification of functioning, disability and health. Geneva: WHO; 2001.

    Google Scholar 

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Acknowledgements

The authors wish to thank Kelly Hall, Natalie Hanson, Claire Malany, Jenna Miller, Chloe Nightingale, Amy Selven, Elizabeth Stump, Magda van Leeuwen, and Isabell Zhu for their assistance with data transcription and analysis.

Funding

This work was funded by the 2018 Evelyn H. Bullock Fund for Communication Disorders and Sciences Research, College of Education, University of Oregon.

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Authors and Affiliations

  1. Department of Communicative Sciences and Deaf Studies, California State University, Fresno, 93740, USA

    Ting-fen Lin

  2. Communication Disorders and Sciences Program, University of Oregon, Eugene, 97403, USA

    Samantha Shune

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  1. Ting-fen Lin
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Correspondence to Ting-fen Lin.

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Portions of this work were presented as a poster presentation at the 2019 Dysphagia Research Society Annual Meeting.

Appendix

Appendix

Interview guide of open-ended questions used during the interview.

  1. 1.

    When were you diagnosed with COPD?

  2. 2.

    Describe the onset of your COPD.

  3. 3.

    What were your feelings/thoughts when you first heard this diagnosis?

  4. 4.

    What action did you take in the first few days/weeks?

  5. 5.

    What do you know about your condition?

  6. 6.

    What symptoms are you currently dealing with?

  7. 7.

    How do these symptoms affect your activities of daily living?

  8. 8.

    How does climbing stairs or carrying heavy loads of grocery make you feel, for example?

  9. 9.

    Thinking about those symptoms you just described, do you experience any of the same during eating/drinking? How do the two activities compare?

  10. 10.

    What do you do when these symptoms come up during eating/drinking?

  11. 11.

    When these symptoms come up in the eating/drinking, how do they affect your eating/drinking?

  12. 12.

    What do you do differently now during eating/drinking to avoid these symptoms from coming up?

  13. 13.

    When the symptoms you mentioned earlier come up during eating/drinking, how do you feel?

  14. 14.

    How does eating/drinking make you feel? What emotions do you associated with eating/drinking?

  15. 15.

    Tell me about the types of food may be more difficult or easier to eat now.

  16. 16.

    How big or small of a bite size do you take?

  17. 17.

    How long does it take you to finish a meal?

  18. 18.

    Do you find yourself modifying the way you drink your liquids?

  19. 19.

    What do you do differently now before/after eating/drinking to avoid these emotions or symptoms from coming up?

  20. 20.

    What does your typical meal look like?

  21. 21.

    What do you think of your overall swallowing?

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Lin, Tf., Shune, S. The Mind–Body–Breath Link During Oral Intake in Chronic Obstructive Pulmonary Disease: A Grounded Theory Analysis. Dysphagia 38, 367–378 (2023). https://doi.org/10.1007/s00455-022-10473-x

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