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Why is Lung Volume Important During Swallowing?

Angela Mansolillo, MA, CCC-SLP, BCS-S

July 1, 2022

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Question

Why is lung volume important during swallowing?

Answer

Indeed, we see that these swallows are occurring at higher lung volumes within liquid boluses and with serial swallows. I am not suggesting that every time you take a sip of water, you fill your lungs to get through it, but swallowing occurs in the mid-range of lung volume. These more challenging swallows occur at the higher part of that mid-range. We have to have some assurance that if we want safe swallowing, our patients can at least get to the middle part of the lung range comfortably and repeatedly. We need that oxygen reserve available because of this period of breath-holding and this potential lack of oxygenation. As brief as it is, think about the demands swallowing places on the respiratory system. It means repeatedly holding your breath briefly, but over, and over, and over, until whatever time it takes for you to complete your meal. It puts much stress on the respiratory system, mainly if we are talking about a respiratory system that already has some compromises. 

The other physiological reason for needing to swallow at a slightly higher lung volume might be to do with airway protection. That enhanced expiratory pressure if you are swallowing at a middle-range lung volume might also help with that exhalatory clearance we discussed a moment ago. We know that when swallows occur at lower lung volumes (near the end of the exhalation, in other words), they are more likely to result in aspiration. Research supports this in patients with COPD and those of us who are "normal breathers" and "normal swallowers." When we get into trouble, we choke or aspirate on something, usually because we were eating and drinking while talking or laughing. Our breathing swallow coordination was off, and we were near end exhalation, so we inhaled when we should have been exhaling, and it gets us into trouble. Even with typical systems, we will sometimes get into trouble regarding this breathing swallow coordination. Suppose we are swallowing at lower lung volumes. This may contribute to discoordination relating to changes in feedback, which the individuals receive from the subglottic pressure receptors. 
 

This Ask the Expert is an edited excerpt from the course, link to If You Cannot Breathe, You Cannot Swallow... Breathing and Swallow Coordination in Respiratory Diseasepresented by Angela Mansolillo, MA, CCC-SLP, BCS-S.


angela mansolillo

Angela Mansolillo, MA, CCC-SLP, BCS-S

Angela Mansolillo, MA/CCC-SLP, BCS-S is a Speech-Language Pathologist and Board Certified Specialist in Swallowing Disorders with over 30 years of experience. She is currently a senior Speech-Language Pathologist at Cooley Dickinson Hospital in Northampton, Massachusetts where she provides evaluation and treatment services for adults and children with dysphagia and is involved in program planning and development for inpatient and outpatient programming including quality improvement initiatives, patient education, and clinical policies and protocols. In addition, she is an adjunct faculty member at Elms College Department of Communication Sciences and Disorders in Chicopee, Massachusetts. Over the course of her career, she has worked in a variety of clinical settings, provided numerous regional and national presentations, and lectured at several colleges and universities throughout Massachusetts. She is a recent recipient of the Massachusetts Speech and Hearing Association’s Award for Clinical Excellence.

Ms. Mansolillo received her Bachelor of Arts degree in communication from Rhode
Island College in 1983 and earned her Master of Arts in Speech-Language Pathology in 1985 from the University of Connecticut. She is a member of the American Speech-Language-Hearing Association and is a member of Special Interest Division 13, which focuses on swallowing and swallowing disorders.


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