What happens in the lungs
The entry of foreign material into the respiratory tract causes two different processes. If this is the acidic contents of the stomach, chemical damage to the lung tissue develops - pneumonitis, which begins in the first hours with shortness of breath, wheezing and a drop in blood oxygen saturation. If saliva or food rich in oral microbes is aspirated, after days pneumonia itself is formed, prone to the formation of purulent cavities. Due to the anatomy of the bronchi, the posterior parts of the upper lobes and lower lobes are most often affected, especially on the right.
- Chemical pneumonitis due to aspiration of gastric juice
- Bacterial pneumonia due to aspiration of saliva and food
- Typical location: lower lobes, often on the right
- Tendency to abscess formation
- Possible development of pleural empyema
- Severe course in weakened patients
Causes and risk factors
The basis is almost always a violation of swallowing or a decrease in protective reflexes. These are stroke and its consequences, dementia, Parkinson's disease, tumors and operations on the pharynx and esophagus, severe intoxication, seizures, anesthesia, coma. Additional contributions are made by gastroesophageal reflux, tube feeding, and prolonged supine position. Poor condition of teeth and gums increases the number of microbes entering the lungs, so oral hygiene is a real preventative measure.
- Stroke and other neurological diseases
- Dementia and disorders of consciousness
- Alcohol abuse
- Anesthesia, coma, seizures
- Gastroesophageal reflux
- Tube feeding and prolonged lying position
- Caries, periodontitis, poor oral care
Symptoms
Sometimes the moment of aspiration is obvious: the person choked, coughed, and began to choke. But in weakened and elderly people, aspiration often occurs unnoticed, especially at night, and the first signs appear after a few days. Fever, cough with sputum, shortness of breath, chest pain, and severe weakness occur. In the elderly, a blurred picture is typical: instead of fever - confusion, refusal to eat, falls, rapid breathing. When suppuration occurs, the sputum becomes profuse, purulent and foul-smelling.
- Coughing and choking while eating
- Fever and chills
- Shortness of breath and rapid breathing
- Chest pain
- Purulent sputum with an unpleasant odor
- Confusion and weakness in the elderly
- Decreased blood oxygen saturation
Diagnostics
The diagnosis is based on a combination of circumstances and examination data. X-ray reveals inflammatory changes in characteristic parts of the lungs, and computed tomography more accurately shows foci of decay and involvement of the pleura. Blood tests show signs of inflammation. Sputum culture and assessment of blood oxygen saturation are helpful. Equally important is a swallowing assessment: a doctor or speech therapist checks how the patient swallows water and food of different consistencies, and, if necessary, an endoscopic or X-ray examination of swallowing is performed.
- Chest X-ray
- CT scan of the chest for suspected abscess
- Complete blood count and C-reactive protein
- Pulse oximetry
- Sputum culture
- Swallowing assessment
- Examination of the oral cavity and teeth
Treatment and prevention
Treatment includes antibacterial therapy, which is selected by the doctor taking into account the likely pathogens of the oral cavity, oxygen support and sanitation of the respiratory tract. For an abscess, the course lasts several weeks. Prevention of recurrent aspiration is key: feeding in a sitting position with the head of the bed elevated, small portions, no talking during meals, changing the consistency of food and thickening liquids as recommended by a specialist, careful oral care and treatment of reflux.
- Antibacterial therapy as prescribed by a doctor
- Oxygen therapy and sanitation of the respiratory tract
- Feeding while sitting, head raised and after eating
- Small portions, slow pace, pause between sips
- Thickening of liquids and changes in food consistency
- Daily oral hygiene and dental treatment
- Treating Reflux and Working with a Swallowing Specialist