New research provides useful guidance regarding use of lubricants to ease swallowing of medicines

A new study designed to describe and compare lubricants which can be purchased in different countries to make tablets and capsules easier to swallow, using an International Standard for assessment of texture, found that whilst many products were potentially suitable for dysphagia, some may not be.1  Some were deemed to be very runny whereas other had very high viscosity which led the authors to suggest that they may be unsuitable if a texture required for a safe swallow was expected to be within the international range. These lubricants are frequently designed for people who just don’t like swallowing tablets or capsules and in such cases it is the individual patient preference which is most important.

The methods suggest that the lubricants were not actually tested with tablets or capsules within them, which is how they are expected to be used and this may affect the results.  Furthermore, as with all of these products, their physical effect on the active ingredients in the medicines themselves are usually not tested. With some evidence that even the simplest of ingredients surrounding a tablet or capsule can potentially affect how well they are absorbed,2 whenever such products are used it is important that the patient is monitored to make sure that effectiveness is not changed.

1. Malouh MA, Cichero JAY, Manrique YJ, Crino L, Lau ETL, Nissen LM, Steadman KJ. Are Medication Swallowing Lubricants Suitable for Use in Dysphagia? Consistency, Viscosity, Texture, and Application of the International Dysphagia Diet Standardization Initiative (IDDSI) Framework. Pharmaceutics. 2020 Sep 28;12(10):924. doi: 10.3390/pharmaceutics12100924. PMID: 32998301; PMCID: PMC7601516.

2. Wright DJ, Potter JF, Clark A, Blyth A, Maskrey V, Mencarelli G, Wicks SO, Craig DQM. Administration of aspirin tablets using a novel gel-based swallowing aid: an open-label randomised controlled cross-over trial. BMJ Innov. 2019 Oct;5(4):113-119. doi: 10.1136/bmjinnov-2018-000293. Epub 2019 Jul 4. PMID: 32038883; PMCID: PMC6979441.

written by by Prof David Wright

Free online course

Dysphagia: Swallowing Difficulties and Medicines

Link: https://www.futurelearn.com/courses/dysphagia

Registration for the course is now open!

The current course is running, you still have time to join.

This course will enhance the knowledge of any person involved in the administration of medicines to patients with dysphagia.

The course offers an opportunity to network with other learners and with the creators of the course through discussions, graphs and social networking features and to share knowledge with other learners and professionals.

The course covers:

  • Definition and causes of dysphagia
  • How to improve medicines administration for patients with dysphagia
  • Supporting patients with dysphagia to take their medicines
  • Different medicine formulations and the important considerations for patients with dysphagia
  • Legal and ethical considerations when administering medicines to patients with dysphagia
  • Standardising the approach to reviewing medicines in patients with dysphagia

Free online course

Dysphagia: Swallowing Difficulties and Medicines

Link: https://www.futurelearn.com/courses/dysphagia

Registration for the course is now open!

The current course opened for registration on the 21st October 2019 and will be open until the 18th of November 2019.

This course will enhance the knowledge of any person involved in the administration of medicines to patients with dysphagia.

The course offers an opportunity to network with other learners and with the creators of the course through discussions, graphs and social networking features and to share knowledge with other learners and professionals.

The course covers:

  • Definition and causes of dysphagia
  • How to improve medicines administration for patients with dysphagia
  • Supporting patients with dysphagia to take their medicines
  • Different medicine formulations and the important considerations for patients with dysphagia
  • Legal and ethical considerations when administering medicines to patients with dysphagia
  • Standardising the approach to reviewing medicines in patients with dysphagia

Free online course

Dysphagia: Swallowing Difficulties and Medicines

Link: https://www.futurelearn.com/courses/dysphagia

Registration for the course is now open!

The current course opened for registration on the 12th of August 2019 and will be open until the 9th of September 2019.

This course will enhance the knowledge of any person involved in the administration of medicines to patients with dysphagia.

The course offers an opportunity to network with other learners and with the creators of the course through discussions, graphs and social networking features and to share knowledge with other learners and professionals.

The course covers:

  • Definition and causes of dysphagia
  • How to improve medicines administration for patients with dysphagia
  • Supporting patients with dysphagia to take their medicines
  • Different medicine formulations and the important considerations for patients with dysphagia
  • Legal and ethical considerations when administering medicines to patients with dysphagia
  • Standardising the approach to reviewing medicines in patients with dysphagia

Future courses will open for registration on:

21st October 2019

Free online course

Dysphagia: Swallowing Difficulties and Medicines

Link: https://www.futurelearn.com/courses/dysphagia

Registration for the course is now open!

The current course opened for registration on the 28th of May 2019 and will be open until the 25th of June 2019.

This course will enhance the knowledge of any person involved in the administration of medicines to patients with dysphagia.

The course offers an opportunity to network with other learners and with the creators of the course through discussions, graphs and social networking features and to share knowledge with other learners and professionals.

The course covers:

  • Definition and causes of dysphagia
  • How to improve medicines administration for patients with dysphagia
  • Supporting patients with dysphagia to take their medicines
  • Different medicine formulations and the important considerations for patients with dysphagia
  • Legal and ethical considerations when administering medicines to patients with dysphagia
  • Standardising the approach to reviewing medicines in patients with dysphagia

Future courses will open for registration on:

12th August 2019

21st October 2019

Research

New international standard for terminology and definitions for texture-modified foods and thickened fluids in Dysphagia Management: The IDDSI Framework

Authors: Cichero JA, Lam P, Steele CM, Hanson B, Chen J, Dantas RO, Duivestein J, Kayashita J, Lecko C, Murray J, Pillay M, Riquelme L, Stanschus S.

Link: https://www.ncbi.nlm.nih.gov/pubmed/27913916

Abstract:

Dysphagia is estimated to affect ~8% of the world’s population (~590 million people). Texture-modified foods and thickened drinks are commonly used to reduce the risks of choking and aspiration. The International Dysphagia Diet Standardisation Initiative (IDDSI) was founded with the goal of developing globally standardized terminology and definitions for texture-modified foods and liquids applicable to individuals with dysphagia of all ages, in all care settings, and all cultures. A multi-professional volunteer committee developed a dysphagia diet framework through systematic review and stakeholder consultation. First, a survey of existing national terminologies and current practice was conducted, receiving 2050 responses from 33 countries. Respondents included individuals with dysphagia; their caregivers; organizations supporting individuals with dysphagia; healthcare professionals; food service providers; researchers; and industry. The results revealed common use of 3-4 levels of food texture (54 different names) and ≥3 levels of liquid thickness (27 different names). Substantial support was expressed for international standardization. Next, a systematic review regarding the impact of food texture and liquid consistency on swallowing was completed. A meeting was then convened to review data from previous phases, and develop a draft framework. A further international stakeholder survey sought feedback to guide framework refinement; 3190 responses were received from 57 countries. The IDDSI Framework (released in November, 2015) involves a continuum of 8 levels (0-7) identified by numbers, text labels, color codes, definitions, and measurement methods. The IDDSI Framework is recommended for implementation throughout the world.

Research

Antipsychotics induce dysphagia and are associated with increased risk of pneumonia

Authors: Cicala G, Barbieri MA, Spina E, de Leon J.

Link: https://www.ncbi.nlm.nih.gov/pubmed/30700161

Abstract:

This is a comprehensive review of antipsychotic (AP)-induced dysphagia and its complications: choking and pneumonia. Areas covered: Four PubMed searches were completed in 2018. The limited literature includes: 1) 45 case reports of AP-induced dysphagia with pharmacological mechanisms, 2) a systematic review of APs as a risk factor for dysphagia, 3) reviews suggesting adult patients with intellectual disability (ID) and dementia are prone to dysphagia (APs are a risk factor among multiple others), 4) studies of the increased risk of choking in patients with mental illness (APs are a contributing factor), 5) naturalistic pneumonia studies suggesting that pneumonia may contribute to AP-increased death in dementia, and 6) naturalistic studies suggesting that pneumonia may be a major cause of morbidity and mortality in clozapine patients. Expert commentary: The 2005 Food and Drug Administration requirement that package inserts warn of AP-induced dysphagia jumpstarted this area, but current studies are limited by: 1) its naturalistic nature, 2) the lack of dysphagia studies of patients with IDs and dementia on APs, and 3) the assumed indirect association between dysphagia with choking and pneumonia. Future clozapine studies on pneumonia, if they lead to a package insert warning, may have high potential to save lives.

Care Home Charter for Swallowing and Medicines

Link: http://www.carehomecharter.org/

The Patients Association UK have developed a charter for use within care homes.

Two versions of the charter exist, one for carers and one for residents and their families.

The Patients Association did some research with care homes and found that many residents were struggling to swallow their medicines. This meant they weren’t always getting the tablets they needed, so a group of healthcare experts developed a Swallowing and Medicines Charter. There are two versions of the Charter one for residents and their families and the other for carers.

Free online course

Dysphagia: Swallowing Difficulties and Medicines

Link: https://www.futurelearn.com/courses/dysphagia

This course will enhance the knowledge of any person involved in the administration of medicines to patients with dysphagia.

The course offers an opportunity to network with other learners and with the creators of the course through discussions, graphs and social networking features and to share knowledge with other learners and professionals.

The course covers:

  • Definition and causes of dysphagia
  • How to improve medicines administration for patients with dysphagia
  • Supporting patients with dysphagia to take their medicines
  • Different medicine formulations and the important considerations for patients with dysphagia
  • Legal and ethical considerations when administering medicines to patients with dysphagia
  • Standardising the approach to reviewing medicines in patients with dysphagia

The current course opened for registration on the 28th of January 2019 and will be open until the 25th of February 2019.

Future courses will open for registration on:

28th May 2019

12th August 2019

21st October 2019

Swallowing problems and stroke – watch the video

New video ‘Swallowing problems and stroke’

Over a million people in the UK are living with the aftermath of having a stroke. The numbers are increasing all the time, and every five minutes another person has one1.

One consequence of having a stroke is difficulty in swallowing, which may affect up to 78% of people2.

A new video ‘Swallowing problems and stroke’ can be viewed on YouTube at: https://www.youtube.com/watch?v=HEmgFVSlV0Q

Hala Jawad, a Practice Pharmacist presents the video, which features Dharinee Hansjee, an expert in stroke and swallowing problems and Janice Clark, a carer who has first hand experience of caring for relatives with swallowing difficulties. The video gives an insight into some of the issues surrounding swallowing problems and stroke, as well as offering practical advice.

The production of this video was supported by Rosemont Pharmaceuticals.

References

1. Stroke Association, State of the Nation Stroke Statistics, 2016

2. RCSLT RESOURCE MANUAL FOR COMMISSIONING AND PLANNING SERVICES FOR SLCN Dysphagia, 2009, updated 2014