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Swallowing Problems in MS

March 22, 2017

Swallowing difficulties and reduced cough are a major, yet commonly overlooked, issue in patients with multiple sclerosis and other brain conditions, according to Dr. Don Bolser, a University of Florida (UF) professor.

Pharmaceutical companies haven’t recognized the importance of preventing bits of food and drink from getting into the lungs while breathing, Bolser said. More research is needed on this issue, he said in a UF News story.

Bolser, a neurologist and neuroscientist, is studying how cough is controlled by the nervous system. He said cough is tightly linked to swallowing — a reflex that healthy people do not pay attention to until they have something go down the wrong pipe.

During swallowing, muscles are coordinated so that the windpipe closes as food or drink is moved from the mouth to the esophagus. While a swallowing problem might intuitively be viewed as difficulty moving food from the mouth to the esophagus, lack of muscle coordination also puts millions of people with various brain conditions at risk of aspiration pneumonia.

Aspiration pneumonia occurs when pieces of food and drink enter the lungs. A weakened cough reflex — also commonly seen in patients with brain damage — prevents a patient from getting the food out of the lungs.

Bolster said studies report aspiration pneumonia death rates of over 60 percent. And aspiration pneumonia strikes in about half of long-term care residents. The treatment is expensive, Bolster added, with each hospital admission costing about $17,000.

Despite these discouraging statistics, Bolster said no pharmaceutical companies are developing drugs to restore weakened swallowing and cough.

The most accepted approach to dealing with impaired swallowing is a recommendation that patients eat thick foods. They are easier to swallow and less likely to enter the airways.