Bronchiectasis and Swallowing Issues - recent study

so, why is it ? What's the mechanism ? I can't find it

Here’s a study from Israel that might help. ? Full text is available. It doesn’t say why people silently aspirate, but shows that more do than thought.
https://pmc.ncbi.nlm.nih.gov/articles/PMC11009759
Here’s info on dysphagia
https://www.nidcd.nih.gov/health/dysphagia#:~:text=swallowing%20a%20pill.-,How%20does%20dysphagia%20occur%3F,in%20the%20mouth%20for%20chewing.

Not sure if the mechanism is fully known, but these two pages from the second link I posted might be helpful. Respiration can effect swallowing, and vice-versa.

that occasional 1-2 sec of swallowing hardly effects the airways , IMO

maybe increased airflow may stress or dry the tissue in the laryngopharynx
and weaken the upper esophageal sphincter

they mention GERD , silent aspiration as possible causes of BE.
under "intoduction" in that Israel 2024 study
referring to
2017 Euro BE-guidelines
2018 British BE-guidelines
(2014) The spectrum of lung disease due to chronic occult aspiration
(2014) Aspiration-related lung diseases
they do not mention that this is still somehow unclear,rare,debated
in these guidelines..
E.g. in one study PPIs made no difference in BE
EMBARC gives GERD=GORD as reason for BE in Europe as 2%
Under "discussion" they mention the relationship of dysphagia with
COPD, which is considered a major cause of BE.
"Aspiration is a preventable cause for bronchiectasis,
with dysphagia being a major etiology for aspiration [17]"
mechanisms:.
1.) inhalation of oropharyngeal secretions colonized by pathogenic bacteria
2.) inhaling gastric contents may result in chemical pneumonitis,
3.) diffuse aspiration bronchiolitis, (rare)
4.) malnutrition by impaired immune function

not very plausible IMO.
These connections would already have been found and observed elsewhere

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what causes dysphagia ?
old age
muscles,nerves,
(no cigarette smoke ?)

Many bronchiectasis centers do swallow testing. They administer thin liquid, puree, and pudding and observe under fluoroscope how well you swallow. Just like we want to prevent reflux and nasal discharge from making its way into the lungs, we also want to make sure poor swallowing doesn't cause an issue. My tests were normal but I still did a series of swallowing exercises with a speech pathology. They were surprisingly difficult!

Linda Esposito

you mean "bronchiectasis centers" or just lung-centers ?
Or :
is dysphagia somehow more related to BE than to other lung diseases ?
Or could that Israel study as well have been done with COPD or Astma
or interstitial lung patients --> giving the same conclusion ?

btw. in the papers you often find Ryu from Mayo for GERD< -->BE
Does he post here ?

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2020 Mayo-paper :
https://www.atsjournals.org/doi/pdf/10.1513/AnnalsATS.201906-427CME
Conclusions
Well-defined aspiration syndromes include
diffuse aspiration bronchiolitis, aspiration-
related OP, ARDS, and exogenous lipoid
pneumonia. In the absence of histologic
evidence of aspiration with foreign bodies
andforeignbodyreactions,thelackofagold-
standard biomarker forgastric-to-pulmonary
aspiration precludes a full understanding of
whether microaspiration may be an
important pathogenic mechanism across a
variety of common chronic respiratory
disorders, including cough, asthma, COPD,
bronchiectasis, and IPF. There is increasing
recognitionthat the changes that occur in the
chest anatomically, physiologically, and
neuronally may be predisposing patients to
esophageal dysfunction, reflux, and
microaspiration. Given the lack of
meaningfulbenefitofgastricacidsuppression
therapies in most cases, a better
understanding of these underlying root
mechanisms will lead to more successful
targets of interventions. In the meantime,
cliniciansshouldnotexclusivelyfocusonacid
reflux as the sole treatable factor for patients
with suspected microaspiration, and clinical
investigations should seek to justify the need
for acid-suppressive therapies and to identify
other predisposing risk factors that might be
aggravating the tendency toward
microaspiration. n

@wolfplanetzero This was news to me last year as well! My issue turned out to be not a swallowing dysfunction, but vocal chord dysfunction. It caused frequent episodes of choking on mucus, saliva, food or beverages for most of my life - and nobody ever diagnosed it - sometimes in spite of witnessing the issue.

Like Linda @becleartoday mine was reduced, over a period of 6 weeks from multiple episodes per day to one every 2-3 weeks - as long as I did the prescribed breathing and swallowing exercises. I declared myself "cured" and stooped the therapy - OOPS - the choking was back within a few weeks. Now I do them daily while working on the computer and I'm better again.

I guess like airway clearance and stretching exercises, these are things you do for life.
Sue

Hi Sue. So far I have had only one appointment with a speech language therapist. She did an evaluation and confirmed the diagnosis of oral dysphagia. We talked about ways of making challenging foods easier to chew and swallow, such as pureeing them, and we did some tongue strengthening exercises, including swallowing while my tongue is sticking out, which was challenging. I will schedule a second appointment when the weather improves and virus case numbers drop. The goals are to keep things from getting worse, and to reduce the risk of aspiration. Peace!

Yes Linda, for those going to NJH they do the barium swallow test for dysphagia. I had it twice with different facilities and so far no problem and hope it stays that way. So much to know and understand.
Barbara.