Aspiration pneumonia is a specific type of pneumonia. In most cases, it occurs because foreign material is inhaled and the respiratory defense system is inadequate. Usually, aspiration pneumonia occurs in the basal portions of the lungs.
What are aspiration pneumonias?
Aspiration pneumonias are characterized by being caused by aspiration of foreign bodies and fluids. A special form among aspiration pneumonias is Mendelson’s syndrome, in which pneumonia occurs after gastric juice enters the airway. This can occur, for example, during the process of vomiting food. If foreign bodies enter the lungs via the airways during eating or vomiting, pathogens are transported into the respiratory organ. These sometimes trigger inflammation in the lungs, so that aspiration pneumonia can develop. For this reason, aspiration pneumonias represent so-called ‘inhaled’ pneumonias.
Causes
Aspiration pneumonias occur as a result of inhalation of foreign bodies into the lungs. Normally, the respiratory tract is protected by certain reflex mechanisms to prevent food particles or gastric juice from entering the respiratory tract during ingestion or vomiting, and from there continuing to the lungs. If such an event nevertheless occurs, a cough reflex occurs as a result of the swallowing, which removes the foreign material from the airways before it can be transported to the lungs. However, situations exist in which the reflex system does not function adequately. Particularly in elderly people or those suffering from certain diseases, the protective reflexes partially fail. The cough reflexes can also be impaired in the context of unconsciousness, for example in alcohol or drug intoxication. If the affected person swallows or vomits without activating the cough reflexes, food components or gastric juice can enter the lungs. This transports pathogens to the lungs, which can cause inflammatory processes. Ingestion of gastric juice presents a special case of aspiration pneumonia, in which the acid irritates the sensitive lung tissue by causing chemical burns.
Symptoms, complaints, and signs
Aspiration pneumonias are associated with various characteristic symptoms and complaints. Usually, as a result of aspiration, there is a severe cough and increased mucus production by the bronchial mucosa. Such signs are often at the beginning of the disease. Later, pneumonia often develops, accompanied by rapid breathing (medical term tachypnea). Fever and a general feeling of illness set in. Depending on the severity of the aspiration pneumonia, dyspnea may be another symptom. In most cases, the typical symptoms of aspiration pneumonia set in with a delay of several hours to a few days. The affected patients show bronchial reactions with a so-called bronchospasm as well as increased secretion. Shortness of breath is often accompanied by cough with expectoration. In addition, the body temperature is measurably elevated. Any dyspnea that occurs (medical term dyspnea) can lead to a bluish or purple discoloration of the skin and mucous membranes (medical term cyanosis) in the further course.
Diagnosis and course
Various methods of investigation are available as part of the diagnosis of aspiration pneumonia. In the first step, the attending physician discusses the recent event of swallowing or vomiting with the patient. As a first examination, the physician usually listens to the lungs with a stethoscope. Audible changes may confirm the suspicion. The diagnosis of aspiration pneumonia can be confirmed by x-rays of the lungs. Changes typical of the disease are visible in the X-ray image. At the same time, the extent of the inflammation can be determined. In addition, blood tests can provide information about the oxygen content of the blood, which makes it possible to determine the oxygen uptake via the lungs. Other diagnostic methods are lung endoscopies or bronchoscopies, which provide a direct view of the lungs. During bronchoscopy or lavage of the bronchial tubes, aspirated material can be found.Computed tomography may also be considered for the purpose of diagnosing aspiration pneumonia.
Complications
Aspiration pneumonia is a feared complication resulting from inhalation of a foreign body. In young children especially, the object can constrict the trachea so much that the child cannot breathe and thus suffocates. In adults, inhalation also causes severe shortness of breath and a coughing fit. The most feared complication of aspiration pneumonia is lung failure (respiratory insufficiency). The patient can no longer take in enough oxygen or release enough carbon dioxide, and suffers from a severe oxygen deficiency, which can be life-threatening. Also life-threatening is when the inflammation spreads throughout the body, causing sepsis. This can end in septic shock, which can then lead to multiple organ failure. In addition, a lot of fluid accumulates in the pleura due to the inflammation (pleural effusion), which affects breathing just as much. Pus can also accumulate in the pleural cavity (pleural empyema), resulting in adhesions of the pleura to the pleura. If the inflammation persists for a long time, it can lead to scarring of the lung tissue (pulmonary fibrosis), which impairs the expansion of the lungs and thus also breathing. Bronchial dilatation is also conceivable (bronchiectasis), which promotes further inflammation and leads to frequent bleeding in the lungs.
When should you see a doctor?
Since aspiration pneumonia has a very negative effect on the lungs and breathing of the affected person, a doctor must be consulted in any case. If treatment is not received, aspiration pneumonia can, in the worst case, lead to the death of the affected person. The doctor should be consulted if the affected person coughs strongly or produces an increased amount of mucus without a specific reason. Similarly, this may cause fever and general fatigue and exhaustion of the patient. Shortness of breath is also a symptom of aspiration pneumonia and must be evaluated by a physician. In an acute emergency, the affected person can also contact a hospital or an emergency physician. Furthermore, there is a cough with expectoration and in some cases a blue discoloration of the skin. If the skin already turns blue, an emergency doctor must be called without fail, as this can also cause damage to the internal organs if they are supplied with too little oxygen. As a rule, the first visit is to a general practitioner. However, in emergencies, it is always necessary to go directly to the hospital or call the emergency doctor to avoid further complications.
Treatment and therapy
Various measures are available for the treatment of aspiration pneumonia, which are used depending on the individual clinical picture and the severity and localization of the disease. First, an attempt should be made to remove the foreign material from the lungs by suction. Administration of airway dilating drugs may facilitate expectoration of the foreign body. The bacteria underlying pneumonia are usually treated with antibiotics. The main aerobic germs in this case are primarily Staphylococcus, Streptococcus, Pseudomonas and Haemophilus. To alleviate the symptoms of respiratory distress, the air breathed can be enriched with oxygen via a nasal probe. In particularly severe cases of respiratory distress, patients may require artificial respiration. In any case, the cause of aspiration must be included in the choice of therapeutic approach.
Outlook and prognosis
The prognosis of aspiration pneumonia depends on several factors. They include the severity and intensity of the pneumonia, the type of bacteria that led to the initiation of the disease, and the size of the affected region. In addition, the age and general health of the patient must be taken into account in the prospects for cure. Normally, in an adult with a good immune system, there is a good chance of a complete cure if treatment is given quickly and without delay. This usually occurs within a few weeks. However, it must be taken into account that people who suffer from aspiration pneumonia often suffer from additional diseases. These weaken the respiratory tract and allow insufficient activity of the gag reflex as well as swallowing in the first place.Functional impairment ultimately leads to the development of aspiration pneumonia and diminishes the prospect of complete recovery. If medical treatment is not sought, the prognosis is unfavorable. Lung abscesses may form, inflammation may develop, and airway function may be impaired. If respiratory function fails acutely, the course of the disease is fatal. The size of the foreign body in the lung is responsible for the extent of tissue damage. After removal of the foreign body, some patients require permanent artificial respiration.
Prevention
To prevent the development of aspiration pneumonia, potential causes should be considered and avoided whenever possible. Accordingly, special attention should be paid to the swallowing process during food intake to prevent foreign bodies from entering the airway. Care should also be taken during vomiting to prevent acidic gastric fluid from entering the trachea. If possible, another person should be involved in the event of aspiration of food or gastric juice, and an emergency physician should be contacted if complications arise.
Follow-up
Most patients with healthy immune systems can completely resolve an illness. For them, the goal is to prevent recurrence. They are responsible for this themselves. Preventive measures include paying adequate attention to swallowing when eating and drinking, for example. Patients who vomit should ensure that gastric fluid does not enter the trachea. If the typical symptoms occur, it is essential to consult a doctor. Sometimes sage tea and other naturopathic remedies help to speed up recovery. According to scientific knowledge, immunity does not exist after a single illness. Patients can therefore become infected again and again. Possible complications should not be underestimated. They often cause long-term damage. The failure of the lungs in particular can have life-threatening consequences. The brain, as the center of human activity, can be so severely attacked that a loss of various basic abilities sets in. Inpatient therapy includes removal of fluids and foreign bodies. The secretion is regularly examined microbiologically in order to initiate an appropriate form of therapy. Doctors administer antibiotics to destroy the pathogens. The progress of recovery or the disease can be clearly shown by X-rays.
What you can do yourself
Aspiration pneumonia can become life-threatening if it is not treated promptly by a professional. Sick individuals must therefore be sure to consult a physician. One of the most important contributions to self-help is to help the physician make a diagnosis. Anyone who notices symptoms of what is thought to be the flu after foreign bodies or stomach acid have entered the lungs should be sure to inform the attending physician about these incidents. The same applies if water has accidentally entered the lungs while swimming or as a result of an accident. The doctor can then examine the patient specifically and detect and treat possible pneumonia in good time; long-term damage to the respiratory organs is then usually not to be feared. Patients who tend to swallow frequently should learn to eat slowly and with concentration, as the risk of contracting aspiration pneumonia increases with each such incident. Those who consistently suffer from acid regurgitation should also have this problem treated promptly to prevent damage to the lungs. Provided aspiration pneumonia has occurred, sufferers can also combat some of the symptoms with mild home remedies. However, this should only be done in addition to the medically prescribed therapy. Cold calf compresses help against the high fever that often occurs. Sage and ribwort are used in naturopathy to combat the increased mucus production and the severe cough.
