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A 68-year-old housewife with spirometry proven chronic obstructive pulmonary disease (COPD) and a current smoker was admitted with increasing shortness of breath and productive cough. On examination, she was found to have bilateral decreased air entry and widespread wheezes. Initial investigations revealed a raised white cell count, but were otherwise unremarkable. She was treated with broad spectrum antibiotics, nebulised β-agonists and steroids.
On review of her chest radiograph (fig 1), a new spiculated lesion in the right mid-zone was noted. In view of her history, a computed tomography (CT) scan of the chest (fig 2) was performed which demonstrated a small endobronchial lesion in the right lower lobe bronchus. She subsequently underwent fibreoptic bronchoscopy where a smooth yellowish lesion was seen in the orifice of the medial basal segment of the right lower lobe (fig 3). This was dislodged and extracted with ease, and identified as a pea. The patient was referred for a swallowing assessment and is at present awaiting video fluoroscopy. She improved symptomatically following bronchoscopy.
Chest radiograph showing spiculated lesion in right mid-zone.
Computed tomography scan of chest showing endobronchial lesion.
Foreign body (pea) as seen on fibreoptic bronchoscopy.
Research suggests that patients with COPD are at increased risk of aspiration due to altered swallowing physiology.1 Studies have demonstrated disrupted coordination of the respiratory cycle with deglutition, resulting in a significantly higher rate of inhalation during or after swallowing.2 This may be the cause of recurrent exacerbations and complications such as pneumonia and patchy pulmonary fibrosis. Oropharyngeal pathophysiology remains an underdiagnosed comorbidity in patients with COPD, and swallowing assessment should be considered with recurrent exacerbations.
Footnotes
Competing interests: none.
Patient consent: Patient/guardian consent was obtained for publication