Pneumonia, a condition in which air sacs in your lungs become inflamed or infected, commonly develops from certain bacteria and viruses that attack the airways and lungs. It can be a complication of a respiratory viral infection such as the flu. But did you know that it can also occur if you accidentally inhale food particles, liquid, saliva, or regurgitated stomach contents into the airways (bronchi) and they get into your lung tissue (alveoli)? This form of pneumonia is called aspiration pneumonia.
The condition is potentially life-threatening. 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.
Infection that begins in your lungs can spread to other places in your body, such as your bloodstream, and can lead to serious complications like sepsis or even to death.
Who’s at risk?
Most of us have experienced swallowing food that “goes down the wrong way.” Our natural reflex is to cough, which clears out foods or liquids before they can reach our lungs. But some people with impaired coughing ability may not be able to do so, making them more vulnerable to developing aspiration pneumonia. Having a reduced ability to close your epiglottis, the lid-like flap of tissue that covers your windpipe when you swallow, also increases your odds of aspiration pneumonia. Other factors that elevate risk include certain health conditions, such as seizures or gastric reflux; lethargy from medication, illness, or other reasons; and drug or alcohol abuse. People who undergo general anesthesia are more susceptible during or immediately after a procedure, which is why fasting before surgery is so important.
You’re also at risk if you have trouble swallowing, a condition known as dysphagia. Swallowing can become more difficult as age and conditions like stroke, advanced dementia, and Parkinson’s disease lead to changes in muscle tone, strength, and coordination in your mouth and tongue and the structures in your throat. When you can’t swallow properly, you’re more likely to inhale food particles and liquid into your lungs. People who are weak or paralyzed are in danger of not realizing they have leftover food in their mouth, which they may inadvertently inhale.
The effects of medications may also make it more difficult to swallow. Some drugs, such as levodopa, diuretics, anticholinergics, antipsychotics, and benzodiazepines can cause dry mouth or affect the central nervous system, leading to impaired swallowing function.
Additionally, research shows links between poor oral hygiene and aspiration pneumonia. When you don’t brush and floss thoroughly, accumulated food debris in your mouth can support the growth of high levels ofmicroorganisms that can be inhaled into your lungs and trigger infection. Wearing dentures at night may also boost your risk, according to a 2015 Japanese study. Dentures—especially when they aren’t thoroughly cleaned—offer microorganisms in your mouth a welcome place to multiply. Inhaling those microorganisms can cause aspiration pneumonia.
Symptoms and treatment
Symptoms of aspiration pneumonia may appear anytime from a day to a week after accidental inhalation. Symptoms can include fever, chills, chest pain, wheezing, shortness of breath, difficulty swallowing, foul-smelling breath, and phlegm that contains pus or is bloody or dark green.
Most people with aspiration pneumonia are initially treated in the hospital. Antibiotics are prescribed for infections; patients who have trouble breathing may also receive supplemental oxygen. For severe cases, patients may be placed on a ventilator.
The prognosis for people with aspiration pneumonia depends on several factors, including the patient’s overall health, the type of bacteria causing infection, and the extent to which the lungs are involved.
Tips for prevention
A few simple steps can help prevent aspiration pneumonia:
- Practice good oral hygiene. Brush, floss, see your dentist regularly, clean dentures well, and don’t wear dentures when you sleep.
- Seek help for swallowing problems. See your doctor, who may refer you to a gastroenterologist,for an accurate diagnosis.
- If you drink alcohol, do so responsibly. Impairment raises your risk of inhaling foods, liquids, or vomit.
- Don’t lie flat in bed. If you have swallowing problems, prop your head up with several pillows or raise the head of the bed when you sleep.
- Review the medications you take with your doctor. He or she may be able to “deprescribe” drugs causing dry mouth or replace them with another drug.
- Get vaccinated. Although respiratory vaccines won’t stop you from inhaling what you shouldn’t, they can help prevent infection from some bacteria and viruses that cause other types of pneumonia.
Hospital-Acquired Pneumonia: What to Know
Pneumonia can develop when you’re hospitalized for something else, known as hospital-acquired pneumonia. Steps such as handwashing and asking sick friends or family members not to visit can help prevent it.
This article first appeared in the April 2019 issue of UC Berkeley Health After 50.
Also see Pneumonia: Causes and Treatments.
Published April 03, 2019