Pulmonary aspiration complexes in adults

Acute occlusion of a mainstem bronchus by a rapidly expanding foreign body

We report a case of an 85-year-old woman who presented with acute respiratory failure, caused by aspirating a sucralfate tablet that totally occluded her left main-stem bronchus. Acute respiratory failure resolved after bronchoscopic removal of the markedly expanded tablet. To our knowledge, the acute obstruction of a main-stem bronchus by an aspirated foreign body has not been previously described in adults. We believe that the unusual properties of sucralfate tablets (rapid expansion and mucosal binding) were contributing factors in this patient.

The association of swallowing dysfunction and aspiration pneumonia

The medical literature has emphasized that aspiration of gastric contents or oral bacteria is a common cause of aspiration pneumonia. Swallowing disorders have been implicated in this disease but not studied at the time that aspiration pneumonia was diagnosed. A significant difference was found in the incidence of videofluoroscopically confirmed oropharyngeal swallowing problems in a group of patients diagnosed with aspiration pneumonia (AP) when compared with patients with nonaspiration pneumonia (NAP). Six of the 9 patients in the AP group aspirated during the videofluoroscopic evaluation and 2 others were considered to be at risk for aspiration. None of the 7 NAP patients demonstrated swallowing problems or aspiration. A significant difference in oral transit time also occurred between the two groups. Liquid was found to have a significantly faster oral transit time than paste or a cookie. Pharyngeal transit times were not found to be significantly different. Although there were only a small number of patients who met the criteria for this pilot study, a strong association was found between swallowing dysfunction and aspiration pneumonia.

Aspiration and the elderly

Aspiration is prevalent in the elderly but its association with impairment of oral intake and gastroesophageal reflux is often misunderstood. This paper describes the causes, pathophysiology, and consequences of aspiration and their unique features in aged persons. It also explains how videofluoroscopic evaluation can assess current function while limiting factors that result in misinformation. The management of aspiration is discussed, emphasizing the importance and difficulties in maintaining functional well-being and possible complications of therapy.