Aerosol generating procedures, dysphagia assessment and COVID-19: a rapid review of the evidence

Lee Bolton, Claire Mills, Sarah Wallace, Marian Brady

Research output: Contribution to journalArticle


In response to uncertainties expressed by UK speech and language therapists (SLTs) and on behalf of the Royal College of Speech and Language Therapists’ (RCSLT) COVID-19 Advisory Group, we reviewed the evidence relating to dysphagia assessment, aerosol generation and risk of COVID-19 transmission.

Our important narrative review was informed by a search of ** electronic databases and search engine (using terms such as COVID-19, SARS-COVID-2, dysphagia, coughing and aerosol), handsearching key medical journals fast-tracking COVID-19 publications, national COVID-19 health policy documents and national and international expert opinion up to **Date** of April 2020. We sought and summarised the available evidence on COVID-19, aerosol generating procedures, dysphagia assessment and risk of transmission.

The WHO concluded that respiratory droplets is a significant route of COVID-19 transmission. Small droplets (aerosols) from COVID-19 positive patients are acknowledged by national health policy and recommendations to result in an increased risk of transmission. Respiratory droplets emitted during a cough are known to include aerosol emissions. Coughing is inherent in dysphagia assessment procedures because of aspiration of food or fluid into the lungs or within the assessment procedure. Despite this, dysphagia assessment is not currently listed as an aerosol generating procedure (AGP) though there is no consensus on a definitive list of AGPs. The 10 primary research studies evaluating the risk of viral transmission during healthcare procedures (which in turn informed a systematic review and in turn national policies) were at high risk of selection bias with only 5 reporting an “other” staff category which may have included speech and language therapists. For healthcare professionals undertaking dysphagia assessment, in prolonged and close contact with patients at high risk of aspiration and prolonged, forceful coughing, the risk of aerosol generation and subsequent increased risk of transmission and infection is clear. Definitive research evidence of an increased risk of infection is absent at present, but it does not follow that there is no increased risk of infection.

Dysphagia assessment should be considered an AGP. There are strong theoretical reasons, some underpinning empirical evidence and consensus from multidisciplinary experts in support of this conclusion. Further evidence relating to COVID-19 and risk of transmission will continue to emerge throughout this pandemic. We urge an inclusive approach to the professionals allied to medicine and nursing staff and the procedures that they undertake in all analysis of risk of COVID-19 (and other viral) transmission and infection.
Original languageEnglish
JournalInternational Journal of Language and Communication Disorders
Publication statusAccepted/In press - 11 May 2020



  • Covid-19
  • dysphagia
  • stroke
  • Aerosol Generating Procedures

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