Shining a spotlight on aspiration pneumonia

The medical condition of pneumonia is commonly known by the majority of individuals. Whether they personally have had the condition or not, they will likely know of someone else who has. But, there is a lesser-known pneumonia, called aspiration pneumonia which is not as familiar to the public.

What’s the difference between pneumonia and aspiration pneumonia?

Pneumonia is when the air sac in your lungs become inflamed or infected.  It commonly develops from certain bacteria and viruses that attach the airways and lungs.  Pneumonia can be a complication of a respiratory viral infection such as the flu.

Aspiration pneumonia is when a person accidentally inhales food particles, medication, liquid, saliva, or regurgitated stomach contents into the airways (bronchi) and it gets into your lung tissue (alveoli). Just like pneumonia, aspiration pneumonia is potentially life-threatening. That’s because the substances breathed into your lungs may be contaminated with bacteria, viruses, or other microorganisms that can cause serious infection, and aspirated stomach acid can inflame and damage lung tissue. As the infection of aspiration pneumonia begins in your lungs spreads to other parts of your body, such as the bloodstream, which can lead to serious complications like sepsis and death.

Who is at risk?

Very few of us have not experienced the sensation of “food going down the wrong way.” When this happens, our natural reflex is to cough helping clear out food or liquids before they reach the lungs.

But if you are someone with an impaired ability to cough, this will make you more vulnerable to developing aspiration pneumonia. Here are other factors which can increase the likelihood of aspiration for anyone:

·      Having a reduced ability to close your epiglottis, the lid-like flap of tissue that covers your windpipe when you swallow

·      Health conditions such as seizures or gastric reflux, being lethargic from medication, illness, or other reasons such as drug or alcohol abuse can increase risk.

·      Anyone undergoing anesthesia are more susceptible right after surgery – this is why fasting before surgery is so important.

·      Anyone who has trouble swallowing, a condition called dysphagia. Swallowing can become more difficult as you age; conditions such as stroke, advanced dementia, and Parkinson’s disease can lead to changes in muscle tone, strength, and coordination in the mouth and tongue and the structures in the throat. Improper swallowing makes you more likely to inhale food particles and liquid into your lungs.

·      Anyone who is weak or paralyzed are in danger of not realizing they have leftover food in their mouth, which can inadvertently leading to inhaling the particles.

·      Certain medications can make it more difficult to swallow. Drugs such as levodopa, diuretics, anti-cholinergics, antipsychotics, and benzodiazepines can cause dry mouth or affect the central nervous system, leading to impaired swallowing.

What are the symptoms of aspiration pneumonia?

The symptoms of this type of pneumonia can appear within minutes to a week after accidental inhalation and can include the following:

·      Fever or chills

·      Chest pain

·      Wheezing and shortness of breath

·      Difficulty swallowing

·      Foul-smelling breath and phlegm that contains pus or is bloody or dark green

How is aspiration pneumonia treated?

The treatment for aspiration pneumonia is to usually be hospitalized in which antibiotics will be prescribed for infection.  Patients who have trouble breathing may also receive supplemental oxygen. In severe cases, some patients may be placed on a ventilator.

Prognosis for aspiration pneumonia depends on the patient’s overall health, the type of bacteria causing the infection and the extent to which the lungs are involved.

How to protect yourself from aspiration pneumonia

There are several steps to take protecting yourself from aspiration pneumonia:

·      Practice good oral hygiene.  Brush, floss, and see your dentist regularly.  Research has shown links between poor oral hygiene and aspiration pneumonia. When a person doesn’t brush and floss thoroughly, food debris can accumulate in the mouth. This will encourage the growth of high levels of microorganisms that can be inhaled into the lungs triggering infection. Proper cleaning of dentures is important as well. Wearing dentures at night can increase the risk of aspiration pneumonia.  If the dentures are not thoroughly cleaned, this can lead to microorganisms growing and multiplying - if they are inhaled, this can lead to aspiration pneumonia.

·      Anyone having trouble swallowing should seek help.  Start with your primary healthcare provider and inquire about getting a referral to a gastroenterologist for an accurate diagnosis.

·      Drink thickened liquids to prevent aspirating into the lungs

·      Avoid lying flat in bed – Prop your head up with several pillows or raise the head of your bed when sleeping.

·      Review medications – Have your doctor review your medications to see if they might cause dry mouth or other side effects increasing risk of aspiration pneumonia.

·      Get vaccinated – Although respiratory vaccines do not stop you from inhaling what you shouldn’t, they can help prevent infection from some bacteria and viruses that cause other types of pneumonia.

David B. Samadi, MD, Urologic Oncology Expert and Robotic Surgeon located at 485 Madison Avenue on the 21st floor, New York, NY.   Follow Dr. Samadi at www.samadimd.com,  www.prostatecancer911.com, and www.roboticoncology.com.