Pulmonary Aspiration

What is pulmonary aspiration?

Pulmonary aspiration is the act of inhaling (breathing in) a foreign material. This material, which could be food, liquid, medicine, mucus, or saliva, then goes into your windpipe (trachea) and lungs instead of your stomach.

Aspiration can cause choking. It can also cause a problem called aspiration pneumonia, which is a serious infection in the lungs.

How does it occur?

Normally, any material that is in the back of your throat is swallowed and goes into your esophagus, the tube that leads 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
• laughing or inhaling when food or fluid is in your mouth.

People who cannot cough very well due to a stroke or other nervous system condition are at the highest risk of aspiration.

What are the symptoms?

The main symptom is choking or coughing before or after you swallow. Choking or coughing is the way that your 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 a silent aspiration. This means they did not have any cough when they inhaled the foreign substance. It is a common problem in people who have a swallowing problem.

How is it diagnosed?

You may be referred to a speech language pathologist who will observe how you swallow liquid and solid foods.

Aspiration can be diagnosed by a test called a videofluoroscopic swallowing study or video swallow. This must be done in a hospital radiology (X-ray) department. You are asked to swallow foods in various amounts and degrees of thickness (usually thin liquids, thickened liquids, pudding, and cookies or crackers) while in a sitting position. You may also be asked to swallow barium. An X-ray video is made that helps find where and when you have problems swallowing.

If your healthcare provider suspects that you have aspiration pneumonia, a chest X-ray is usually taken.

How is it treated?

There is no treatment for aspiration itself. Aspiration pneumonia is treated with antibiotic medicine.

How can it be prevented?

Prevention is the key to managing aspiration. Many different therapies can be used to decrease the risk of aspiration. Which therapy is right for you will depend on the results of the swallowing study. Some examples include:

• doing tongue exercises
• holding your head and chin down while swallowing
• tilting your head to the side on which you swallow better
• using a thickener product in liquids
• changing the texture or temperature of foods
• limiting the amount of food you put in your mouth at one time.

How can I help take care of myself?

• Do not talk or laugh when you are drinking or have food in your mouth.
• Avoid foods or medicines that you have trouble swallowing. Ask your healthcare 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 healthcare provider?

Call your provider if:

• You have a swallowing or choking problem that gets worse.
• You start having shortness of breath or wheezing that does not go away.
• You have a fever after a choking attack.
• You have trouble swallowing and your healthcare provider does not yet know about it.