Assess aspiration and swallowing
Assess annually for overt or silent aspiration and signs of swallowing difficulty (eg, throat clearing after swallowing, coughing, choking, drooling, long meal times, aversion to food, weight loss, and frequent chest infections or asthma) or when these signs are detected.164
Strongly Recommended
Empirical Experiential Expert
Respiratory disorders (eg, aspiration pneumonia) are among the common causes of death for people with IDD.158 Swallowing difficulties can increase the risk of aspiration or asphyxiation.159-163 Such difficulties are prevalent among people with neuromuscular dysfunction (eg, cerebral palsy) or those who are taking medications with anticholinergic effects.
Refer to speech and language pathologist
Refer to a speech and language pathologist to assess swallowing function when signs and symptoms of swallowing difficulty are detected.159
Strongly Recommended
Empirical Experiential Expert
Respiratory disorders (eg, aspiration pneumonia) are among the common causes of death for people with IDD.158 Swallowing difficulties can increase the risk of aspiration or asphyxiation.159-163 Such difficulties are prevalent among people with neuromuscular dysfunction (eg, cerebral palsy) or those who are taking medications with anticholinergic effects.
Screen for asthma
Screen for asthma. Consider other causes of a cough or wheeze, such as aspiration.165
Strongly Recommended
Empirical Ecosystem
Asthma is more prevalent among people with IDD than in the general population.165, 166
Diagnosis
Use spirometry or pulmonary function tests to confirm the diagnosis of asthma. These might need to be adapted to the needs of some people with IDD who find these tests difficult.165
Strongly Recommended
Empirical Ecosystem
Asthma is more prevalent among people with IDD than in the general population.165, 166
Screen for COPD
Ask about smoking and exposure to second-hand smoke. Screen for chronic obstructive pulmonary disease (COPD) as in the general population.165
Recommended
Ecosystem
Chronic obstructive pulmonary disease (COPD) is more prevalent in adults with IDD than adults without IDD.165
Screen for sleep apnea
Screen for obstructive sleep apnea (see Sleep Problems).241-243
Recommended
Empirical Expert
Chronic obstructive pulmonary disease (COPD) is more prevalent in adults with IDD than adults without IDD.165
158. Patja K, Molsa P, Iivanainen M. Cause-specific mortality of people with intellectual disability in a population-based, 35-year follow-up study. J Intellect Disabil Res. 2001;45:30-40.
159. Chadwick DD, Jolliffe J. A descriptive investigation of dysphagia in adults with intellectual disabilities. J Intellect Disabil Res. 2009;53(1):29-43.
160. Marks JH. Pulmonary care of children and adolescents with developmental disabilities. Pediatr Clin North Am. 2008;55(6):1299,314, viii.
161. Rogers B, Stratton P, Msall M, Andres M, Champlain MK, Koerner P, et al. Long-term morbidity and management strategies of tracheal aspiration in adults with severe developmental disabilities. Am J Ment Retard. 1994;98(4):490-8.
162. Thillai M. Chapter 7: Respiratory diseases. In: O’Hara J, McCarthy JM, Bouras N, editors. Intellectual disability and ill health: a review of the evidence. Cambridge ; New York: Cambridge University Press; 2010. p. 78-87.
163. McCaslin CA, Schuen JN. Chapter 107: Pulmonology and sleep disordered breathing. In: Rubin IL, Merrick J, Greydanus DE, Patel D, editors. Health care for people with intellectual and developmental disabilities across the lifespan. Rubin and Crocker 3rd ed. Springer; 2016. p. 1325-46.
164. Perez CM, Ball SL, Wagner AP, Clare ICH, Holland AJ, Redley M. The incidence of healthcare use, ill health and mortality in adults with intellectual disabilities and mealtime support needs. Journal of Intellectual Disability Research. 2015;59(7):638-52.
165. Lin E, Selick A, Balogh RS, Isaacs BJ, Ouellette-Kuntz HMJ, Klein-Geltink JE, et al. Chapter 2: Prevalence, demographic and disease profiles. In: Lunsky Y, Klein-Geltink JE, Yates EA, editors. Atlas on the primary care of adults in Ontario. Toronto: Centre for Addiction and Mental Health and Institute for Clinical Evaluative Sciences; 2013. p. 20-40.
166. Gale L, Naqvi H, Russ L. Asthma, smoking and BMI in adults with intellectual disabilities: A community-based survey. J Intellect Disabil Res. 2009;53(9):787-96.
241. Stores G. Sleep and its disorders in children and adolescents with a neurodevelopmental disorder: A review and clinical guide. Cambridge University Press; 2014.
242. Wallace RA, Dalton AJ. Clinicians’ guide to physical health problems of older adults with down syndrome. Journal on Developmental Disabilities. 2006;12(1 (Supplement 1)):1-92.
243. Lal C, White DR, Joseph JE, van Bakergem K, LaRosa A. Sleep-disordered breathing in down syndrome. Chest. 2015;147(2):570-9.
