One of the most serious health risks to patients who have difficulty swallowing is that of developing aspiration pneumonia. “Aspiration” is the medical term for when food or liquids go into the wind pipe (trachea) and then into the lungs when swallowing. Repeated aspiration can eventually lead to pneumonia.
Of course the best way to reduce the risk of aspiration pneumonia is to have a thorough swallowing evaluation from an experienced speech pathologist who can identify what foods and drinks are safest for you and what type of therapy may help improve your swallowing.
In addition to consulting with a speech pathologist, there are other things you can do to lessen the chance of pneumonia even more.
Research (Langmore et al, 1998) has identified some surprising factors that put a person who has difficulty swallowing at a greater risk of aspiration pneumonia:
- Poor oral care/dependency on others for oral care: The presence of aspiration during swallowing is bad enough already, but it can be further worsened by what is aspirated. Poor oral care results in higher amounts of bacteria in the mouth, and these oral bacteria can contribute to pneumonia if they make their way to the lungs. If oral care is not good, food, liquid, and even saliva will pick up this oral bacteria and transport it to the lungs if it is aspirated. So while it’s bad that the food, liquid, or saliva has entered the lungs, the problem is made even worse by the addition of the oral bacteria as well. So oral care that includes scrubbing the tongue and gums with a toothbrush and using a good antiseptic mouth rinse reduces the risk of oral bacteria entering the lungs.
- Dependency on others for feeding. An unfortunate fact is that in many health care facilities the people who assist patients in eating are often under pressure to feed as many patients as possible in a short amount of time. This can result in large bites of food being presented too quickly, and a rushed meal doesn’t allow for strategies that can help with swallowing difficulty such as doing extra swallows for each bite or taking sips of liquid to rinse away particles of food. This all adds up to a greater risk of aspiration and pneumonia. If you have a family member in a health care setting with difficulty swallowing, inquire about if the staff has been trained on dysphagia and the risk of aspiration during feeding. The caregivers who feed patients likely do not know that they may be putting their patients at risk with the feeding techniques they use.
- Poor pulmonary clearance and weak cough. Speech pathologists love it when people cough. OK, that sounds a little strange, but coughing is the body’s natural protection against aspiration so a strong cough reflex, particularly for someone who has dysphagia, is good. If the cough is weak, that can often be improved in swallowing therapy. In addition to having a strong cough, another natural deterrent of pneumonia is being physically active, and any amount of physical activity is better than sitting still in a bed or chair all day. A person who gets out of bed and moves around is less likely to develop pneumonia than someone who is not as active.
- A dry mouth fosters increased oral bacteria. A common side effect of many medications is a dry mouth or Xerostomia. When saliva is decreased, oral bacteria can build up and increase the risk of gingivitis and tooth decay. This brings us back to the first point about oral bacteria traveling to the lungs. Lungs and oral bacteria just do not mix. If your medications cause dry mouth, talk with the doctor who prescribed the medication to see if another medication that does not have that side effect could be substituted.
- Lying down after eating. The risk of aspiration doesn’t go away after the meal is over. People with difficulty swallowing can have small particles of food remain in the throat after swallowing. Gravity is our friend in these instances, and the longer a person stays upright the better chance these particles have in making their way to the stomach. If the food particles stay in the throat, it is much easier for them to fall into the airway as soon as the person lies down. There is also the risk of stomach contents, which increase after eating, coming back up into the throat and being aspirated when lying down. So stay upright and let gravity work in your favor for as long as possible after eating.
- Smoking. Add aspiration pneumonia to the long list of health risks that can result from smoking. Smoking increases the “pollution” in the mouth and decreases pulmonary function for clearing aspiration. A dirty mouth and poor ability to cough is a recipe for disaster for someone with dysphagia. So the risk of aspiration pneumonia is yet another reason to quit smoking.
So in addition to following the medical advice provided by your doctor or speech pathologist, arm yourself with these defense mechanisms to further decrease your chances of aspiration pneumonia.
Staying healthy while you recover from dysphagia is what it’s all about!
Langmore S, Terpenning M, Schork A, Chen Y, Murray J, Lopatin D, Loesche W. Predictors of Aspiration Pneumonia: How Important Is Dysphagia? Dysphagia 13:69–81 (1998).
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