Abstract

Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide, and its economic and social burden is projected to keep rising over the next decades. Beyond airflow limitation, COPD is increasingly recognized to affect swallowing, and oropharyngeal dysphagia is now understood as an underdiagnosed comorbidity that may itself contribute to disease exacerbations. This narrative review summarizes current evidence on the pathophysiological mechanisms linking dysphagia and COPD, the prevalence of swallowing impairment across disease stages, available screening and diagnostic tools, and the impact of dysphagia-focused rehabilitation. A literature search of MEDLINE/PubMed, Scopus, and Embase was conducted for studies published through June 2026. The evidence indicates that impaired breathing–swallowing coordination, reduced laryngopharyngeal sensitivity, and COPD-related biomechanical changes of the thorax and upper airway increase the risk of penetration and aspiration, and that dysphagia is associated with a higher frequency of COPD exacerbations; prospective cohort data indicate that this relationship is not merely cross-sectional, with detectable aspiration predicting subsequent severe exacerbations. Only a minority of patients are formally screened for dysphagia, despite the availability of validated, low-cost tools. Emerging intervention studies suggest that structured dysphagia education and rehabilitation, integrated into pulmonary rehabilitation programs, can improve swallowing-related quality of life and functional status, although the evidence base for specific therapeutic techniques remains limited. Given its expertise in functional rehabilitation, physical and rehabilitation medicine (PRM) is well positioned to lead the integration of dysphagia screening and management into multidisciplinary COPD care.

Keywords

COPD, chronic obstructive pulmonary disease, dysphagia, deglutition, deglutition disorders, exacerbations, aspiration, rehabilitation