A Study of Selection of Drugs to Treat Basal Diseases with Considerating of Influence on the Swallowing Function in the Patients Undergoing Swallowing Rehabilitation

Abstract

Elderly patients often require continuous medication with a number of drugs to treat basal diseases, and there is the potential for these drugs to affect swallowing function. In order to preserve swallowing function and prevent diseases such as aspiration pneumonia, we must support drug choices for which the effects upon swallowing function is considered. We conducted a retrospective study on the status of administration of drugs that affect swallowing function and the influences of these effects in the acute stroke patients with dysphagia that were undergoing swallowing rehabilitation at Kochi University Hospital. We found that out of 55 such patients, 37 (67.3%) were taking drugs that affected swallowing function. The breakdown by drug type was 14 patients (25.5%) taking drugs that improved swallowing function, 16 (29.1%) taking drugs that reduced swallowing function, and 7 patients (12.7%) taking both kinds of drugs. We also confirmed that there are cases in which drug selection needs to take into account the effects of the regimen on swallowing function, such as when the existing regimen has a 1:4.6 ratio of ACE inhibitors to ARB, where drugs that reduce the risk of aspiration pneumonia will be outweighed by those that lack such action. Since many patients have also been found to develop dysphagia because of a lowered consciousness level, it is necessary to consider drug selection and dose levels for antipsychotics and anticholinergic drugs. We investigated the effect of drugs that influence swallowing function in patients. We found that the patients in the group who took drugs that improved swallowing function were able to maintain a higher degree of swallowing function at the start of swallowing rehabilitation, compared to other groups. The group of patients taking drugs that reduced swallowing function ended the swallowing rehabilitation program with a lower level of swallowing function than others. Based on the above results, we think that pharmacists should proactively involve themselves in drug selection and methods of use tailored to the specific pathological condition of each individual patient with dysphagia, with the goal of improving patient QOL.