Modifying Textures

It is thought that the chance of aspiration is dependent on the consistency of the bolus. Kuhlemeier, Palmer, & Rosenberg (2001) has proven that the thickness of a liquid is inversely proportionate to the rate of aspiration, as in the thicker the liquid, the less likely it is for aspiration to occur. In the COPD population aspiration is already a concern, especially as there is a high rate of silent aspiration (Good-Fratturelli, Curlee, & Holle, 2000). It is also believed that the way the food is given to the patients affects the chance of aspiration. Kuhlemeier, Palmer, & Rosenberg (2001) included the comparison of delivering the different consistencies by either a spoon or a cup. They found that aspiration was a greater concern with a cup than with a spoon. This could be because patients were thought to take larger amounts from a cup. Therefore, decreasing the size of the patient's bite could make swallowing easier.
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One technique thought to reduce aspiration is alternating between liquids and solids whilst eating (Good-Fratturelli, Curlee, & Holle, 2000; Coelho, 1987). The idea behind alternatin between solids and liquids is that it decreases pharyngeal stasis (Good-Fratturelli, Curlee, & Holle, 2000). However, as thin liquids are harder to swallow they may increase aspiration.
There is growing evidence that using carbonated liquids decreases aspiration when compared to thin liquids (Bulow, Olsson, & Ekberg, 2003). There appears to be a shorter pharyngeal transit time for carbonated liquids which could explain why they are less likely to cause aspiration (Bulow, Olsson, &Ekberg, 2003). It is an area that needs more literature but there does seem to be studies that support this theory. Considering this, if a patient does not enjoy thickened liquids then it is possible that usin carbonated drinks will be more enjoyable and decrease the risk of aspiration.


References:

Bulow, M., Olsson, R., & Ekberg, O. (2003). Videoradiographic of how carbonated thin liquids and thickened liquids affect the physiology of swallowing in subjects with aspiration on thin liquids. Acta Radiologica, 44, 366-372.
Coehlo, C. (1987). Preliminary findings on the nature of dysphagia in patients with Chronic Obstructive Pulmonary Disease. Dysphagia, 2, 28-31.
Good-Fratturelli, M., Curlee, R., & Holle, J. (2000). Prevalence of nature of dysphagia in VA patients with COPD referred for videofluoroscopic swallow examination. Journal of Communication Disorders, 33, 93-110.

Kuhlemeier, K., Palmer, J., & Rosenberg, D. (2001). Effect of liquid bolus consistency and delivery method on aspiration and pharyngeal retention in dysphagia patients. Dysphagia, 16, 119-122.