Aspiration Pneumonia

Aspiration pneumonia is a type of pneumonia that might occur if a person breathes something into the lungs instead of swallowing it. If left untreated, complications can be serious, even fatal.

Causes

The 3 pillars of aspiration pneumonia are poor oral health status, impaired health status and dysphagia (impaired laryngeal valve integrity).

Viruses and bacteria can cause pneumonia, which is an infection that can lead to inflammation of the lungs and airways. In aspiration pneumonia, a person accidentally breathes a substance into their lungs instead of swallowing it. The substance, such as food, saliva, vomit, or medication, brings in bacteria, which can cause the infection.

Healthy lungs can usually handle the microbes from these types of accidents and get rid of as much of it as possible through a cough. People who have trouble coughing, are less alert, are already ill, or those with compromised immune systems are more prone to aspiration pneumonia. Aspiration pneumonia also accounts for about 5-15% of all community-acquired pneumonia cases. About 18% of all aspiration pneumonia cases occur in nursing homes.

In normal healthy adults, the mucociliary mechanism and alveolar macrophages (a type of white blood cells) act as defenses in clearing micro aspirations from the oropharyngeal secretions. The pathological process of aspiration pneumonia occurs when the normal defense mechanisms fail in a predisposed individual. The entry of fluid into the bronchi and alveolar space triggers an anti-inflammatory reaction with the release of proinflammatory cytokines. Inoculation of organisms of common flora from the oropharynx and esophagus results in aspiration pneumonia. If the bacterial load of aspirate is low normal host defenses will clear the secretions and prevent infection.

This pneumonia remains one of the common complications following general anesthesia. It's also common in children. It occurs frequently in hospitals, where lots of germs may be involved in causing it.

Risk Factors

There are many risk factors that contribute to a higher risk for developing an aspiration pneumonia. This list includes a dependency upon others for feeding (the dominant risk factor for aspiration pneumonia), dependence for oral care, poor oral health, dental problems that interfere with chewing or swallowing, limited or infrequent ambulation, compromised respiratory system, impaired cough function, previous aspiration pneumonia, compromised immune system, gastrointestinal disease and currently a smoker.

Aspiration pneumonia generally occurs in older patients with negative health-related and functional characteristics, as well as 2 or more chronic comorbidities.

Symptoms

Patients with aspiration pneumonia have a higher morbidity and mortality than those with community-acquired pneumonia. Some people who aspirate do not have any signs or symptoms. This is called silent aspiration. But aspiration can cause symptoms such as sense of food sticking in the throat or coming back into the mouth, pain when swallowing, trouble starting a swallow, coughing or wheezing after eating, chest discomfort or heartburn, fever 30 minutes to an hour after eating, too much saliva, feeling congested after eating or drinking, having a wet-sounding voice during or after eating or drinking, shortness of breath or tiredness while eating and vomiting blood. Pneumonia may come back again and again.

Symptoms of aspiration start very quickly, even one to two hours after inhaling something you shouldn't have. It may take a day or two for pneumonia to develop.

How do you know if a patient is at risk for aspiration? If a patient is pocketing food in the mouth/cheeks, clearing the throat or coughing while eating, drooling, or displaying any difficulty breathing with eating or drinking, these are indicators of possible aspiration.

Aspiration in Children

Some children have trouble swallowing because of throat muscle problems caused by physical conditions such as a cleft palate, delayed growth, brain damage, nerve problems and muscle diseases like spinal muscular atrophy.

Common symptoms of aspiration in babies and children include weak sucking, choking, or coughing while feeding, red face, watery eyes, or grimacing while feeding, breathing that speeds up or stops while feeding, slight fever after feeding, breathing problems like wheezing and frequent respiratory infections.

Aspiration can happen during a feeding or meal. And it can happen after a feeding or meal. This is common in babies and children with certain health conditions. Aspiration can also happen at any time when your child swallows saliva.

If your child aspirates a small amount of material, it may not cause much harm. This can happen in children who don’t have a health problem. It can happen when eating, sleeping, or talking. But aspiration that happens often or in a large amount can be serious.

Complications

Aspiration pneumonia can cause severe complications, especially if a person waits too long to go to the doctor. The infection may progress quickly and spread to other areas of the body. It may also spread to the bloodstream, which is especially dangerous. Pockets or abscesses may form in the lungs. In some cases, pneumonia, respiratory failure or death.

Diseases that affect swallowing or cause further inflammation may make aspiration pneumonia worse or prevent it from healing properly. Some severe infections may result in long-term damage and scarring in the lungs and major airways.

Preventing Aspiration

When you’re eating and drinking, avoid distractions, such as talking on the phone or watching TV. Cut your food into small, bite-sized pieces. Always chew your food well before swallowing. Eat and drink slowly. Sit up straight when eating or drinking if you can. If you’re eating or drinking in bed, use a wedge pillow to lift yourself up. Stay in an upright position (at least 45 degrees) for at least 1 hour after you eat or drink.

Place your infant in an upright position during feedings. To ensure that your baby’s foods and liquids are swallowed properly, elevate your baby’s head by at least 30 degrees during feedings. Gravity will make it easier for your baby to swallow and help the food or liquids move safely into your baby’s stomach. If your infant is able to sit up, encourage him to do so every time he eats, particularly once he starts consuming more solid foods.

Keep your baby upright for 90 minutes after feeding. Give your infant smaller, more frequent meals. This will give your baby more time to swallow properly and have less food to digest in between feedings, reducing the risk of aspiration.

Feeding your baby at a slow, controlled pace can help him learn to suck in, swallow, and then breathe properly to avoid aspirating. Add a thickener if your baby has trouble drinking liquids. Rice cereal and infant oatmeal are some of the most frequently used thickeners. Give your baby an infant-safe antacid if they have GERD.