Aspiration Pneumonia: Overview, Causes and Symptoms
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Getting a Handle on Aspiration Pneumonia

What is aspiration pneumonia?

Highlights

  1. Aspiration pneumonia accounts for as much as 15 percent of pneumonia cases acquired outside of hospitals.
  2. Bacteria, stomach acid, and undigested food can all contribute to the respiratory problems associated with aspiration pneumonia.
  3. Aspiration pneumonia is typically treated with antibiotics.

Aspiration pneumonia is an inflammation of your lungs and bronchial tubes that occurs after you inhale oral or gastric contents. Though it is not the most common type of pneumonia, it is not unusual to contract aspiration pneumonia.

Aspiration pneumonia is caused by inhaling materials such as vomit, food, or liquid. Your mouth and throat normally contain many species of bacteria that are aspirated along with the oral or gastric contents. These bacteria can grow in the lungs, which becomes pneumonia. The types of bacteria that most often cause this kind of pneumonia are known as anaerobic bacteria. This includes peptostreptococcus, bacteroides and Prevotella bacteria families. E. coli can also be the culprit. It is important to remember that the oral or gastric contents can damage the lung tissue as well and cause inflammation known as chemical pneumonitis.

More commonly found kinds of bacterial pneumonia, known as community-acquired pneumonia (CAP), are usually caused by streptococcus and pneumococcus bacterias.

Aspiration pneumonia accounts for as much as 15 percent of pneumonia cases acquired outside of hospitals.

What causes aspiration pneumonia?

Causes

Aspiration generally leads to bacterial pneumonia along with some degree of chemical pneumonitis. Viruses and fungi can also cause pneumonia but not generally with aspiration. Your immune system usually fights these invaders off, preventing them from infecting your lungs. However, there are occasions when the germs can overpower the immune system.

Under normal circumstances, only air should enter the lungs. Aspiration pneumonia is more likely to occur if something is preventing your normal gag reflex. This can be due to a brain injury (which can occur due to stroke or trauma), medical conditions such as myasthenia gravis, Parkinson’s disease, dementia, multiple sclerosis (MS), and amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease), or even excessive use of alcohol, prescription, or illegal drugs. Aspiration pneumonia can also be associated with esophageal disorders, anesthesia, and dental problems that interfere with chewing or swallowing. Sometimes, the swallowing muscles can become weak with age or inactivity, for example, a patient who is on mechanical ventilation for several days or longer. Aspiration can occur in these situations as well. Finally, persons with normal swallowing and a normal gag reflex can aspirate and develop pneumonia if their food or drink simply “goes down the wrong way.”

Some people can effectively expel enough of the aspirate to prevent pneumonia by creating a strong cough, but some people have an impaired coughing ability. This is especially common in people who are unconscious or have brain injuries that lead to a decreased level of consciousness. Many of us aspirate small amounts of saliva each night while sleeping but we do not develop aspiration pneumonia due both to our ability to clear the aspirate and a fairly healthy immune system. Persons that are immunocompromised such as those on chemotherapy or other immunosuppressive drugs are at higher risk for developing pneumonia when they aspirate.

Who is at risk for aspiration pneumonia?

Risk Factors

The highest risk of this condition is seen in older adults with a history of:

  • lung disease
  • seizure
  • stroke
  • dental problems
  • dementia
  • swallowing dysfunction
  • impaired mental status
  • certain neurologic diseases
  • radiation therapy to the head and neck

People with heartburn (gastroesophageal reflux) and gastroesophageal reflux disease (GERD) also are at increased risk.

What are the symptoms of aspiration pneumonia?

Symptoms

The symptoms of this condition are similar to other types of pneumonia. They include:

  • chest pain
  • shortness of breath
  • wheezing
  • fatigue
  • blue discoloration of the skin
  • cough, possibly with green sputum, blood, or a foul odor
  • difficulty swallowing
  • bad breath
  • excessive sweating

If you have any of these symptoms, contact your doctor and let them know if you’ve recently inhaled any food or liquids.

Anyone that is exhibiting these symptoms should use caution and contact their doctor. However, it is especially critical that a child under 2 years old, or an adult over the age of 65, get medical attention and a quick diagnosis. If you are coughing up colored sputum or have a lingering fever over 102° in addition to the symptoms mentioned above, do not hesitate to go to the emergency room.

If you think you might have this condition, talk to your doctor as soon as possible. Prompt treatment can make a big difference in your recovery.

How is aspiration pneumonia diagnosed?

Diagnosis

Your doctor might find additional signs of aspiration pneumonia during a physical exam, such as:

  • decreased flow of oxygen
  • rapid heart rate
  • crackling sound in the lungs

Your doctor will run a series of tests to diagnose you. These may include:

  • sputum culture
  • complete blood count (CBC)
  • arterial blood gas
  • bronchoscopy
  • CT scan of chest area
  • swallowing tests
  • blood culture
  • chest X-ray

Your doctor may also need to test your ability to swallow. They may ask you to take a barium swallow during your X-ray. This is called a barium swallow study, and it can give your doctor a better picture of any swallowing problems you may have.

Since pneumonia is a serious diagnosis that requires treatment, you should have the results of your tests within 24 hours, if not sooner. However, it may take several kinds of tests to positively identify aspiration pneumonia.

How is aspiration pneumonia treated?

Treatment

Your treatment will depend on the severity of your pneumonia. The first line of treatment will probably be antibiotics. Severe pneumonia may need to be treated in the hospital. People with trouble swallowing may need to stop taking food by mouth.

Choosing the right antibiotics can be difficult. The bacteria that cause this condition may be hard to identify. There are some things your doctor will need to know to identify the appropriate medication:

  • whether you were recently hospitalized
  • your overall health
  • if you’ve used antibiotics recently
  • where you live

Antibiotics specific to aspiration pneumonia will most likely be prescribed to you. They may include clindamycin, flagyl, zosyn, levaquin, maxipime or rocephin, and merrem. If you are treated with oral antibiotics at any point in the course of your illness, make sure to take the antibiotics for the entire length of the prescription period, which can vary from seven to 14 days.

Aspiration pneumonia can cause breathing problems, so you may need help to breathe. You may be prescribed oxygen, steroids, and/or breathing treatments. Mechanical ventilation may also be used to assist with your breathing if your case is severe.

Outcomes and duration of treatment vary greatly depending on your general health, pre-existing conditions, and individual hospital policies.

How can aspiration pneumonia be prevented?

Prevention

You can reduce your risk of this condition by:

  • avoiding behavior that leads to aspiration, such as excessive drinking
  • recognizing the risks of aspiration in certain situations
  • receiving proper dental care on a regular basis

If your doctor has identified that you’re at risk of developing aspiration pneumonia, you should undergo a comprehensive swallow evaluation. A licensed speech pathologist or licensed swallow therapist evaluates this comprehensive test.

Those who are at high risk of aspiration pneumonia should drink alcohol in moderation and be careful with any medication that may cause sedation. If you are scheduled for elective surgery, you should also make sure to follow your doctor’s orders about fasting before surgery. This will help lower the chance that you will vomit under anesthesia

What can be expected in the long term?

Outlook

Many people who have this condition also have other diseases that affect swallowing. This can affect recovery especially if you continue to have significant episodes of aspiration during the recovery period.

Your overall outlook depends on:

  • how much of your lungs have been affected
  • the severity of the pneumonia
  • the type of bacteria causing the infection
  • any underlying medical condition that compromises your immune system or you ability to swallow

Without the right treatment, pneumonia can cause long-term problems such as a lung abscess or permanent scarring. Some people will develop acute respiratory failure. This could be fatal.

Aspiration pneumonia is a very serious medical condition, but it’s treatable. If you’re at a high risk, it’s important to follow the prevention methods and to contact your doctor immediately if you notice any of the symptoms. Sometimes aspiration pneumonia can signal other underlying health problems that affect your ability to swallow. Your doctor may order tests to identify these potential other conditions if they are suspected. 

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