Sometimes as SLPs, we get so focused on the relationship between dysphagia, aspiration, and respiratory compromise that it's easy to forget how many disease processes can impact the lungs. Coughing itself is the number one symptom reported to physicians overall. It can be really tempting to see a patient with a complicated lung history, note that they cough with PO, and make assumptions or even diet changes based on just this clinical information.
Our Modified Monday this week comes from our Detroit team, and is a great example of why we really shouldn't do this to our patients... even if it seems "safer". The patient was noted to have a history of: pneumonia, COPD exacerbation, recent COVID-19, aspiration pneumonia, respiratory failure, asthma, pulmonary fibrosis, AND hypoxia. Oh-and chronic cough. The treating SLP at the facility noted cough with PO, as well as when NOT eating-the patient had been placed on honey thick liquids at some point, but the cough persisted. The facility SLP referred to our team for a study. Given all of the medical history and clinical signs/symptoms, our team was expecting dysphagia, but found... really functional and beautiful physiology.
Dysphagia is a symptom of a disease process that can in turn cause other disease processes, like lung/respiratory problems. BUT it is FAR from the ONLY cause of these diseases. And since things that we do (like thickening liquid or changing diets) to mitigate the "risk" of dysphagia causing respiratory complications
can have further negative impacts on a patient's health (like dehydration and malnutrition), we need to do what we can to be CERTAIN that these things we do to manage dysphagia are actually NECESSARY.
The other consideration here is the potential overdiagnoses of aspiration pneumonia-it's a very broad diagnosis and there is quite a bit of variation in how it is diagnosed between institutions. See below link for an overview on this.
The long story short: don't judge a book by the cover and assume that respiratory compromise and coughing history is a sure sign of dysphagia and aspiration-we need instrumentals to tell us the real story.