What are the predisposing conditions for aspiration pneumonia?

Updated: Aug 15, 2018
  • Author: Justina Gamache, MD; Chief Editor: Guy W Soo Hoo, MD, MPH  more...
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Answer

Answer

Almost all patients who develop aspiration pneumonia have one or more of the predisposing conditions listed below. Although all the listed conditions predispose the patient to chemical pneumonitis, conditions that alter consciousness and periodontal disease specifically predispose the patient to bacterial pneumonia.

The basic pathogenesis of any aspiration event involves impaired swallowing, whether related to medications, anatomy, or neurologic dysfunction. A group that warrants special mention is head and neck cancer patients; they are considered a high-risk group. While likely acknowledged, the importance of the swallowing disorder is not well appreciated. Speech therapy can provide some amelioration of risk and is also under used in these patients.

Conditions associated with altered or reduced consciousness, including any condition that reduces a patient's gag reflex, ability to maintain an airway, or both, increase the risk of aspiration pneumonia or pneumonitis. Such conditions are as follows:

  • Alcoholism

  • Drug overdose

  • Seizures

  • Stroke

  • Head trauma

  • Intracranial mass lesion

Esophageal conditions associated with aspiration pneumonia include the following:

  • Dysphagia: Oropharyngeal dysphagia has been found in the majority of elderly patients (mean age, 84 y). [3]

  • Esophageal strictures

  • Esophageal neoplasm

  • Esophageal diverticula

  • Tracheoesophageal fistula

  • Gastroesophageal reflux disease

Neurologic disorders also predispose to aspiration pneumonia, such as the following:

  • Multiple sclerosis

  • Dementia

  • Parkinson disease

  • Myasthenia gravis

  • Pseudobulbar palsy

Aspiration pneumonia is also associated with the following mechanical conditions:

  • Nasogastric tube [4]

  • Endotracheal intubation

  • Tracheostomy

  • Upper gastrointestinal endoscopy

  • Bronchoscopy

  • Gastrostomy or postpyloric feeding tubes

Other types of associated conditions are as follows:

  • Protracted vomiting

  • Prolonged recumbency

  • General deconditioning and debility

  • Critical illness


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