The association between dysphagia and the risk of acute exacerbation of chronic obstructive pulmonary disease (AECOPD): a systematic review and meta-analysis

Objective Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) significantly impair patients' quality of life and contribute to higher healthcare burdens and mortality. Recent evidence suggests a potential link between dysphagia and AECOPD. This meta-analysis aims to quantitatively evaluate the impact of dysphagia on the risk of AECOPD. Methods A comprehensive systematic search was conducted across multiple databases, including PubMed, SinoMed, Web of Science, Embase, China National Knowledge Infrastructure (CNKI) and the Cochrane Library, to identify cohort studies reporting on the association between dysphagia and AECOPD. The search covered all publications from the inception of each database to May 31, 2025. Two researchers independently performed literature screening, data extraction, and quality assessment. Meta-analysis was performed using RevMan 5.4 and Stata 15.0, with pooled risk ratios (RR) calculated employing the Mantel-Haenszel method under a random-effects model. Results Seven studies involving 669 patients were included in the analysis. Meta-analysis showed that dysphagia significantly increased both the risk of acute exacerbations in COPD patients (RR=2.37, 95% CI: 1.75–3.20, p<0.00001) and the annual number of annual exacerbations (MD=1.13, 95% CI: 0.88–1.38, p<0.00001). The Egger test indicated publication bias (p=0.022); after trim and fill adjustment, the revised RR was 1.85 (95% CI: 1.35–2.53). Sensitivity analyses confirmed the robustness of these results. Subgroup analyses according to publication year, country, age, study design, lung function, dysphagia assessment methods, definition of a frequent exacerbator, and study quality did not significantly change the results. Conclusion This systematic review and meta-analysis shows a significant association between dysphagia and increased risk of AECOPD. The findings highlight the importance to add swallowing function screening to standard COPD management. Future research should explore underlying mechanisms and potential confounders further.