Chronic obstructive pulmonary disease (COPD) is a chronic lung condition. Symptoms include breathing difficulty, cough, feeling short of breath, and chest tightness. Along with breathing issues, some people notice other changes too.

Sometimes, COPD can cause swallowing problems. Swallowing problems are known as dysphasia. Usually, swallowing and breathing are carefully controlled. This prevents food and liquids from getting into your lungs.

In COPD, this coordination doesn’t always work quite right. Problems with swallowing can affect your quality of life. It may also increase your risk of pneumonia if food or drink gets into your lungs.

Along with swallowing problems, you may experience other nutritional challenges. At more advanced stages of COPD, it takes more energy to breathe. It can be hard to eat enough to meet your needs.

Here are some answers to common questions that people have about COPD and swallowing.

Dysphagia is the medical term for having difficulty with swallowing. Although swallowing is a complex process, much of the time, it happens automatically. There are many things that need to work just right for a typical swallow to happen.

The acts of breathing and swallowing share some parts but they can’t happen at the same time.

There are two tubes that travel down your throat and into your chest. One is the trachea, where air travels to get to your lungs. The other is the esophagus, which brings food and fluids into your stomach.

A small flap of cartilage called the epiglottis helps ensure that food and fluids go the right way. The epiglottis closes over your larynx during swallowing. This prevents food or fluids from getting into your lungs.

The larynx is located at the top of your trachea and is also known as the voice box. Many people with COPD have changes in the muscles involved in swallowing. Muscle changes can be from inflammation, medications, or from malnutrition.

During a typical swallow, breathing is paused for a second or two. But when you have COPD and it’s hard to get enough air, that moment of the airway being blocked during a swallow is too long. Your airway may try to open during the swallow and food and fluids may get in.

In a typical swallow, breathing out (exhaling) happens after the swallow ends. If you have COPD, you may experience changes in your swallowing patterns. You may be more likely to breathe in (inhale) after swallowing. This makes it more likely that food or liquids that are being swallowed could end up in your lungs.

It’s impossible to breathe and swallow at the same time. There are controls in place in your body to make sure they happen separately. During a swallow, breathing is paused for a second or two.

In someone without COPD, this time without breathing isn’t a major issue. But when it’s already difficult to get enough oxygen, that second can be too long. The need for oxygen can override swallowing.

Many people with COPD breathe more rapidly. When the lungs can’t get enough oxygen, breathing may be more shallow and rapid. With less time between breaths, there’s less opportunity for a brief pause to safely swallow.

Difficulty with swallowing in COPD may also happen because the esophagus can’t clear the acid from the stomach. The esophagus may also have trouble opening and closing because of weakened muscles in the diaphragm.

COPD can cause changes throughout the respiratory system. The trachea is just one part of that system. The trachea is also known as the windpipe. The trachea starts at your throat, then branches into smaller tubes called bronchi.

The bronchi lead to your lungs. Inside the lungs, the bronchi divide into smaller pathways called bronchioles. At the end of the bronchioles are tiny air sacs called alveoli. The alveoli are the site where oxygen can enter the bloodstream.

The trachea is made of cartilage which makes it flexible.

A study looked at changes in the trachea when breathing in compared to breathing out. In someone without COPD, the trachea stays about the same size and shape. In people with COPD, the trachea gets narrower when you breathe out.

It’s thought that the cartilage that makes up the trachea is weaker in someone with COPD. Narrowing of the trachea was seen in people with COPD whether their condition was stable or was in a flare-up. In this study, that happened in 35 percent of people with stable COPD and 39 percent of those having a flare-up.

The trachea also gets more inflamed if you have a respiratory infection. Inflammation can narrow airways and increase the production of mucus.

COPD also affects your smaller airways. They can get inflamed and create more mucus. This creates less space to bring air and oxygen into your body. The alveoli (the tiny air sacs in your lungs) also lose elasticity, or flexibility. Air gets trapped in them and that means there’s less room for new air to enter.

The throat is also known as the pharynx. The middle section is used as a pathway to both the stomach via the esophagus and the lungs via the trachea. This middle section is called the oropharynx. It’s in constant contact with the brain to help coordinate breathing and swallowing.

COPD can affect the sensors in your throat, causing them to respond slower than usual. This means that the brain may be slow to start a swallow. There are a few reasons to explain these changes.

It’s possible that medications, including steroid inhalers, can cause damage over time. There may also be swelling in the back of the throat from smoking or a chronic cough.

People with dysphagia are at greater risk of pneumonia. Pneumonia is an infection in the lungs. It can be caused by bacteria, viruses, or fungi.

Pneumonia can happen if food or liquids are breathed into the lungs. This is known as aspiration pneumonia. If you have both COPD and dysphagia, you may be at greater risk of disease flare-ups and pneumonia.

In later stages of COPD, the risk of malnutrition can increase. Malnutrition is when you aren’t able to get enough energy and nutrients from food. As it takes more and more energy to breathe, it becomes harder to eat enough. Dysphagia further increases the risk of malnutrition.

Signs and symptoms of malnutrition may include:

  • unintended weight loss or difficulty maintaining your weight
  • increased fatigue
  • being more prone to infection
  • feeling lightheaded or dizzy
  • bloodwork showing low nutrient levels
  • changes in your mood, including depression
  • feeling weaker
  • loss of muscle mass

If you notice any of these signs, make sure to discuss them with your healthcare team. You may need support with increasing your nutrient intake.

A speech-language pathologist (SLP) and a dietitian may be able to help. They can assess your swallowing ability. Based on the findings, they can help you with swallowing safely and increasing your nutrient intake.

COPD can affect your ability to swallow. You may experience changes in the coordination of breathing and swallowing if you have COPD. The muscles that control swallowing may be weaker. The sensors that help regulate swallowing may be slower to respond.

Dysphagia makes it more likely that food or fluids could end up in your lungs, where they can cause infection.

Working with your healthcare team is important. Make sure to mention any changes with your swallowing. You can get support to help you swallow more safely and boost your nutrition.