Speech Pathology: Reflux Aspiration and Lung Diseases

  • Anne E. VertiganEmail author


There are a range of conditions associated with reflux, aspiration and lung disease that are managed by speech-language pathologists (SLP). In many cases the SLP role is to treat the symptoms or consequences of the disease while management of the underlying disease is the role of the medical practitioner. Laryngeal conditions related to reflux, aspiration and lung disease can result in hypo or hyperlaryngeal function. They include oropharyngeal dysphagia, and laryngeal hyperresponsiveness syndromes such as chronic refractory cough, paradoxical vocal fold movement, muscle tension dysphonia and globus pharyngeus. This chapter outlines the speech pathology assessment and treatment of these conditions.


  1. 1.
    Steidl E, Ribeiro CS, Gonçalves BF, Fernandes N, Antunes V, Mancopes R. Relationship between dysphagia and exacerbations in chronic obstructive pulmonary disease: a literature review. Int Arch Otorhinolaryngol. 2015;19(1):74–9.PubMedGoogle Scholar
  2. 2.
    Groher M, Crary M. Dysphagia: clinical management in adults and children. St. Louis: Mosby Elsevier; 2010.Google Scholar
  3. 3.
    Addington WR, Stephens R, Widdicombe J, Rekab K. Effect of stroke location on the laryngeal cough reflex and pneumonia risk. Cough. 2005;1(1):4.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Addington WR, Stephens RE, Gilliland KA. Assessing the laryngeal cough reflex and the risk of developing pneumonia after stroke: an interhospital comparison. Stroke. 1999;30(6):1203–7.CrossRefPubMedGoogle Scholar
  5. 5.
    Ward K, Seymour J, Steier J, Jolley CJ, Polkey MI, Kalra L, et al. Acute ischaemic hemispheric stroke is associated with impairment of reflex in addition to voluntary cough. Eur Respir J. 2010;36(6):1383–90.CrossRefPubMedGoogle Scholar
  6. 6.
    Hu X, Yi ES, Ryu JH. Aspiration-related deaths in 57 consecutive patients: autopsy study. PLoS One. 2014;9(7):e103795.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Hu X, Lee JS, Pianosi PT, Ryu JH. Aspiration-related pulmonary syndromes. Chest. 2015;147(3):815–23.CrossRefPubMedGoogle Scholar
  8. 8.
    Langmore SE, Terpenning MS, Schork A, Chen Y, Murray JT, Lopatin D, et al. Predictors of aspiration pneumonia: how important is dysphagia? Dysphagia. 1998;13(2):69–81.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Hinchey JA, Shephard T, Furie K, Smith D, Wang D, Tonn S. Formal dysphagia screening protocols prevent pneumonia. Stroke. 2005;36(9):1972–6.CrossRefPubMedGoogle Scholar
  10. 10.
    Logemann JA, Veis S, Colangelo L. A screening procedure for oropharyngeal dysphagia. Dysphagia. 1999;14(1):44–51.CrossRefPubMedGoogle Scholar
  11. 11.
    American Speech-Language-Hearing Association. Guidelines for speech-language pathologists performing videofluoroscopic swallowing studies [Guidelines]. 2004 [cited 2015 1/5/2015]. Available from
  12. 12.
    Nacci A, Ursino F, La Vela R, Matteucci F, Mallardi V, Fattori B. Fiberoptic endoscopic evaluation of swallowing (FEES): proposal for informed consent. Acta Otorhinolaryngol Ital. 2008;28(4):206–11.PubMedPubMedCentralGoogle Scholar
  13. 13.
    Sura L, Madhavan A, Carnaby G, Crary MA. Dysphagia in the elderly: management and nutritional considerations. Clin Interv Aging. 2012;7:287–98.PubMedPubMedCentralGoogle Scholar
  14. 14.
    Pitts T, Rose MJ, Mortensen AN, Poliacek I, Sapienza CM, Lindsey BG, et al. Coordination of cough and swallow: a meta-behavioral response to aspiration. Respir Physiol Neurobiol. 2013;189(3):543–51.CrossRefPubMedGoogle Scholar
  15. 15.
    Langmore SE, Pisegna JM. Efficacy of exercises to rehabilitate dysphagia: a critique of the literature. Int J Speech Lang Pathol. 2015;17(3):222–9.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Fujiwara S, Ono T, Minagi Y, Fujiu-Kurachi M, Hori K, Maeda Y, et al. Effect of supraglottic and super-supraglottic swallows on tongue pressure production against hard palate. Dysphagia. 2014;29(6):655–62.CrossRefPubMedGoogle Scholar
  17. 17.
    Langmore SE, Skarupski KA, Park PS, Fries BE. Predictors of aspiration pneumonia in nursing home residents. Dysphagia. 2002;17(4):298–307.CrossRefPubMedGoogle Scholar
  18. 18.
    Langdon PC, Lee AH, Binns CW. High incidence of respiratory infections in ‘nil by mouth’ tube-fed acute ischemic stroke patients. Neuroepidemiology. 2009;32(2):107–13.CrossRefPubMedGoogle Scholar
  19. 19.
    McGrail A, Kelchner L. Barriers to oral fluid intake: beyond thickened liquids. J Neurosci Nurs. 2015;47(1):58–63.CrossRefPubMedGoogle Scholar
  20. 20.
    Panther K. The Frazier free water protocol. Perspect Swallowing Swallowing Disord (Dysphagia). 2005;14:4–9.CrossRefGoogle Scholar
  21. 21.
    Ryan N, Gibson P. Cough reflex hypersensitivity and upper airway hyperresponsiveness in vocal cord dysfunction with chronic cough. Respirology. 2006;11(Suppl 2):A48.Google Scholar
  22. 22.
    Vertigan AE, Bone SL, Gibson PG. Laryngeal sensory dysfunction in laryngeal hypersensitivity syndrome. Respirology. 2013;18(6):948–56.CrossRefPubMedGoogle Scholar
  23. 23.
    Morrison M, Rammage L, Emami A. The irritable larynx syndrome. J Voice. 1999;13(3):447–55.CrossRefPubMedGoogle Scholar
  24. 24.
    Dicpinigaitis PV, Tso R, Banauch G. Prevalence of depressive symptoms among patients with chronic cough. Chest. 2006;130(6):1839–43.CrossRefPubMedGoogle Scholar
  25. 25.
    Vertigan AE, Theodoros DG, Winkworth AL, Gibson PG. Perceptual voice characteristics in chronic cough and paradoxical vocal fold movement. Folia Phoniatr Logop. 2007;59(5):256–67.CrossRefPubMedGoogle Scholar
  26. 26.
    Stemple J, Glaze L, Klaben B. Clinical voice pathology: theory and management. 4th ed. Brisbane: Plural Publishing; 2010.Google Scholar
  27. 27.
    Boone D, McFarlane S, VonBerg S, Zraick R. The voice and voice therapy. 8th ed. Sydney: Allyn & Bacon; 2009.Google Scholar
  28. 28.
    Verdolini K, Rosen C, Branski R. Classification manual for voice disorders-I. Mahwah: Lawrence Erlbaum Associates; 2006.Google Scholar
  29. 29.
    Birring S. Controversies in the evaluation and management of chronic cough. Am J Respir Crit Care Med. 2011;183(6):708–15.CrossRefPubMedGoogle Scholar
  30. 30.
    Gibson PG, Chang AB, Glasgow NJ, Holmes PW, Katelaris P, Kemp AS, et al. CICADA: cough in children and adults: diagnosis and assessment. Australian cough guidelines summary statement. Med J Aust. 2010;192(5):265–71.PubMedGoogle Scholar
  31. 31.
    Birring S, Prudon B, Carr A, Singh S, Morgan M, Pavord I. Development of a symptom specific health status measure for patients with chronic cough: Leicester Cough Questionnaire. Thorax. 2003;58:339–43.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Vertigan A, Bone S, Gibson PG. Development and validation of the Newcastle laryngeal hypersensitivity questionnaire. Cough. 2014;10(1):1.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Shembel AC, Rosen CA, Zullo TG, Gartner-Schmidt JL. Development and validation of the cough severity index: a severity index for chronic cough related to the upper airway. Laryngoscope. 2013;123(8):1931–6.CrossRefPubMedGoogle Scholar
  34. 34.
    Gartner-Schmidt J, Shembel AC, Zullo T, Rosen CA. Development and validation of the dyspnea index (DI): a severity index for upper airway-related dyspnea. J Voice. 2014;28(6):775–82.CrossRefPubMedGoogle Scholar
  35. 35.
    Vertigan A, Theodoros D, Gibson P, Winkworth A. Voice and upper airway symptoms in people with chronic cough and paradoxical vocal fold movement. J Voice. 2007;21(3):361–83.CrossRefPubMedGoogle Scholar
  36. 36.
    Jacobson H, Johnson A, Grywalski C, Silbergleit A, Jacobson G, Benninger M. The voice handicap index (VHI): development and validation. Am J Speech Lang Pathol. 1997;6:66–70.CrossRefGoogle Scholar
  37. 37.
    Belafsky PC, Postma GN, Koufman JA. Validity and reliability of the reflux symptom index (RSI). J Voice. 2002;16(2):274–7.CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Vertigan A, Theodoros D, Gibson PG, Winkworth A. Efficacy of Speech pathology management for chronic cough: a randomised placebo controllled trial of treatment efficacy. Thorax. 2006;61(12):1065–9.CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Vertigan A, Theodoros D, Winkworth A, Gibson P. Chronic cough: a tutorial for speech language pathologists. J Med Speech Lang Pathol. 2007;15:189–206.Google Scholar
  40. 40.
    Mathers-Schmidt B. Paradoxical vocal fold motion: a tutorial on a complex disorder and the Speech-Language pathologists role. Am J Speech Lang Pathol. 2001;10:111–25.CrossRefGoogle Scholar
  41. 41.
    Kaltenbach T, Crockett S, Gerson LB. Are lifestyle measures effective in patients with gastroesophageal reflux disease? An evidence-based approach. Arch Intern Med. 2006;166(9):965–71.CrossRefPubMedGoogle Scholar
  42. 42.
    Ness-Jensen E, Hveem K, El-Serag H, Lagergren J. Lifestyle intervention in gastroesophageal reflux disease. Clin Gastroenterol Hepatol. 2015;6(15):00635–7.Google Scholar
  43. 43.
    Haruma K, Kinoshita Y, Sakamoto S, Sanada K, Hiroi S, Miwa H. Lifestyle factors and efficacy of lifestyle interventions in gastroesophageal reflux disease patients with functional dyspepsia: primary care perspectives from the LEGEND study. Intern Med. 2015;54(7):695–701.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.John Hunter HospitalNew Lambton HeightsAustralia
  2. 2.Centre for Asthma and Respiratory DiseasesUniversity of NewcastleCallaghanAustralia
  3. 3.Hunter Medical Research InstituteNew Lambton HeightsAustralia

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