Aspiration Prevention

What is Aspiration Pneumonia?
Aspiration pneumonia is an inflammation of the lungs and bronchial tubes. Inhaling foreign material (usually food, drink, vomit, or secretions from the mouth) causes this, and the condition may progress to the collection of pus in the lungs, also known as lung abscess.

How does it occur?
Normally, any material that is in the back of your throat is swallowed and goes into your esophagus, the tube leading to your stomach. Your windpipe sits in front of the esophagus and leads to your lungs.  Swallowing is automatic and complex. It is coordinated with breathing to prevent anything in your throat from going down into your lungs.  When this coordination is lost, aspiration can occur.  Some things that can cause such a problem are:

• nervous system disorders,  such as a stroke or multiple sclerosis
• a defect in some part of the throat or vocal cords
• a breathing disorder,  such as chronic obstructive
• pulmonary disease (COPD)
• gastroesophageal reflux disease (GERD)
• medicines or surgery
• loss of consciousness
• laughing or inhaling when food or fluid is in the mouth
• high gastric residual volumes
• the use of an endotracheal tube
• imperfections in the aerodigestive tract

People who cannot cough due to a stroke or other nervous system conditions are at the highest risk of aspiration. People with decreased levels of consciousness,  or thoracic postoperative patients are also at risk.

What are the symptoms?
The main symptom is choking or coughing before or after swallowing.  Choking or coughing is the way that the body tries to remove something from the windpipe. Other symptoms can include a shortness of breath or wheezing that comes on quickly.

Many people have what is called silent aspiration. This means they do not cough when inhaling the foreign substance. It is common in people with a swallowing problem. 

How is it diagnosed?
Aspiration can be diagnosed by a test called a videofluoroscopic swallowing study, or video swallow. This is done in a hospital's radiology department. Patients are asked to swallow foods in varying amounts and degrees of thickness (usually thin liquids, thickened liquids, pudding, and cookies or crackers) while in a sitting position. Patients may also be asked to swallow barium.   An X-ray video is made that helps find where and when the patients have problems swallowing.  Patients may also be referred to a speech language pathologist who will observe how they swallow liquid and solid foods. 

If aspiration pneumonia is suspected, a chest X-ray is usually taken.

How can it be prevented?
Prevention is the key to managing aspiration.  Different therapies can be used to decrease the risk of aspiration.
Treatment depends on the results of the tests the patient undergoes. Some treatment examples include:

• doing tongue exercises
• holding the head and chin down while swallowing
• tilting the head to the side on which the patient
• using a thickener product in liquids swallows better
• changing the texture or temperature of foods thats in their mouths at one time
• Limiting the amount of food patients puts in their mouths at one time  

Family members watching over semiconscious or comatose loved ones are encouraged to play a part in preventing aspiration pneumonia. This can be done by:

• performing regular cleaning of the mouth
• elevating the head of the patient to ease swallowing,  and if necessary, coughing
• observing that the patient swallows adequately
• maintaining a calm, serene environment while the patient eats or drinks
• consulting with speech therapists and dieticians to address the patient's particular needs

Doctors also have their own methods of detecting and preventing aspiration pneumonia. These are particularly important for bedridden patients or patients who are tube-fed. These include:

• Using food coloring in food to detect its presence in the lungs
• Monitoring airway cuff pressure
• Positioning the patient at a 45-degree angle to prevent food from slipping into the windpipe
• Making sure the feeding tube is securely in the stomach
• Using a nasogastric (NG) tube for feeding

How can I help take care of myself?

• Do not talk or laugh when you are drinking or chewing food.
• Avoid foods or medicines that you have trouble swallowing. Ask your health care provider about a different form of medicine that may be easier for you to swallow, such as coated tablets, capsules, or liquid medicine.
• Follow the therapies recommended for you if you have had a swallowing study.  

When should I call my health care provider?
Call your provider if:

• Your swallowing or choking problem gets worse.
• You develop shortness of breath or wheezing that does not go away.
• You have a fever after a choking attack.
• You have trouble swallowing and your health care provider does not know about it.

References :
https:// www.neurosy.org /disease/aspiration/pneu.shtml
https://www.fairview.org/healthlibrary/content/aha_pulaspir_crs.htm

Note:   This information is not intended to be used as a substitute for professional medical advise, diagnosis or treatment.   If you or someone you know have any of the symptoms mentioned above, it is advisable to seek professional help.

For any questions, you may call the The Medical City Nursing Office Homecare Service.

CENTER FOR PATIENT PARTNERSHIP

Tel. No. (632) 988-1000 / (632) 988-7000 ext. 6444