Although chronic obstructive pulmonary disease (COPD) primarily affects your ability to breathe, it can also have a negative impact on your ability to swallow. Difficulty swallowing is known as dysphagia.

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 as intended.

Difficulty swallowing can affect your quality of life. It may also increase your risk of pneumonia if food or drink gets into your lungs.

You may also 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 nutritional needs.

Although swallowing is a complex process, much of the time, it happens automatically. Many things 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 simultaneously.

Two tubes 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.

In a typical swallow, breathing out (exhaling) happens after the swallow ends. If you have COPD, you may experience changes in your swallowing patterns.

During a typical 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. Your airway may try to open during the swallow, and food and fluids may get in.

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 swallow safely.

Many people with COPD have changes in the muscles involved in swallowing. Muscle changes can be from inflammation, medications, or from malnutrition.

Difficulty 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 and 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 2017 study looked at changes in the trachea when breathing in compared to breathing out.

Researchers found that, in people without COPD, the trachea is about the same size and shape during inhalation and exhalation. In people with COPD, the trachea narrows during exhalation.

In this study, 35% of people with stable COPD and 39% of people with an active COPD flare-up experienced narrowing of the trachea.

It’s thought that the cartilage that makes up the trachea is weaker in people with COPD.

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, leaving 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.

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 of the lungs. Bacteria, viruses, or fungi can cause it.

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 the later stages of COPD, the risk of malnutrition can increase. Malnutrition is when you can’t 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 and a dietitian may be able to help. They can assess your swallowing ability, help you learn how to swallow safely, and increase 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 in your swallowing. You can get support to help you swallow more safely and boost your nutrition.