Swallowing in acute exacerbation of COPD
Research type
Research Study
Full title
Is swallowing impaired during an acute exacerbation of chronic obstructive pulmonary disease (COPD); a feasibility and methodological development study
IRAS ID
275304
Contact name
Sarah Elkin
Contact email
Sponsor organisation
Imperial College Healthcare NHS Trust / Imperial College London Joint Research Compliance Office
Clinicaltrials.gov Identifier
tbc, Researchregistry.com
Duration of Study in the UK
2 years, 3 months, 0 days
Research summary
Summary of Research
Admission to hospital with an acute exacerbation of chronic obstructive pulmonary disease (AECOPD) affects approximately 10% of people over 45 years old and is a major NHS cost. Between 2017-2018, there were approximately 334 admissions for AECOPD to Imperial College Healthcare NHS Trust. Swallowing problems (dysphagia) have been demonstrated in patients with stable COPD and, where present, may lead to chest infection through aspiration (food or liquid entering the airway). However, it is not known if aspiration is worse during an acute exacerbation, and, if so, whether this prolongs the infection and increases length of stay. This study will develop and test the feasibility of a methodological framework to evaluate the role of swallowing problems in acute exacerbation of COPD.
Specifically, we will study whether it is possible, in practice, to investigate swallowing in people admitted with AECOPD and during the early recovery period. We will also collect the views of patients and the public about investigating swallowing problems at this time point, as well as their views on the research design, dissemination and techniques used.
Data to be collected will include simple clinical data, standardised health status questionnaires, and objective measures of breathing and swallowing function used normally in clinical practice. The study will provide sufficient data to examine whether it is feasible to collect this data set for a future larger trial. The results will be used to inform sample size calculations, recruitment targets, and primary and secondary outcome measures.
Summary of Results
The results from this feasibility study show that it is not possible to recruit participants to the study in its current design. There are a number of reasons for this. Some patients were not asked whether they would like to take part in the research whilst they were in hospital. This was because the medical team looking after them felt that the patient was either too unwell or too frail to take part at that time, or that they expected the patient would be leaving hospital in the next 24-48 hours and there not be enough time to take part. Patients were also being asked to take part in other research studies on COVID19 happening at the same time which may have been considered more important. In total, three patients were contacted by the researcher and declined to take part in this study due to feeling too unwell and wanting to prioritise getting home.
The majority of patients who were admitted to hospital with an acute exacerbation of COPD stayed on average 6-7 days. However, the number of days patients spent in hospital most often was only two. This was likely to have had an impact on recruiting patients to the study. It was not possible for the researcher to visit suitable patients until the next working day. Although only three patients were asked to take part, the short stay in hospital reduced the amount of time available to carry out the consent and data collection processes. In addition, the second time point for data collection would not have been possible for patients who stayed less than four days in hospital. A small number of patients were admitted over a weekend when the researcher was not available. This also reduced the time available for the study. The learning from this study is being used to improve the design of a future study.
Lastly, people with chronic obstructive pulmonary disease (COPD) were classed as ‘extremely clinical vulnerable’ during the pandemic with government advice to shield at home. This reduced the overall number of hospital admissions of potentially suitable COPD patients compared to previous years.
REC name
London - Brighton & Sussex Research Ethics Committee
REC reference
20/LO/0550
Date of REC Opinion
27 Aug 2020
REC opinion
Further Information Favourable Opinion