Aspiration Pneumonia

Excerpt

Aspiration pneumonia is an infectious pulmonary condition triggered by entering bacteria-rich oropharyngeal fluids into the lower respiratory tract. The aspirated fluid may contain oropharyngeal secretions, particulate matter, or gastric content. Aspiration pneumonia manifests across various clinical contexts and primarily affects older adults. It poses significant risks of morbidity and mortality among individuals with learning disabilities and those with gastrointestinal (GI) or neurologic disorders, predisposing them to abnormal swallowing.

Aspiration pneumonia encompasses both community-acquired and healthcare-associated forms, constituting a physiopathological occurrence that lacks a precise definition. According to a recent review following clinical practice guidelines from Japan, aspiration pneumonia diagnosis hinges on the presence of lung inflammation in patients exhibiting evident aspiration, with documented dysphagia, or a clinical condition strongly associated with aspiration or dysphagia. An infectious process, aspiration pneumonia entails the proliferation and invasion of pathogenic bacteria from the inhaled fluid into the pulmonary parenchyma.

Aspiration pneumonitis differs from aspiration pneumonia in clinical presentation. While both occur following an aspiration event, aspiration pneumonitis manifests as a noninfectious chemical lung injury from inhaling sterile fluid or gastric contents.

Clinicians and healthcare institutions must maintain a high suspicion of aspiration pneumonia in patients susceptible to this condition to ensure accurate diagnosis and mitigate complications. However, the existing literature lacks comprehensive guidance in this regard. Moreover, definitively diagnosing aspiration pneumonia, particularly in cases involving multiple microaspirations, poses a significant challenge. Empiric therapy for patients with aspiration pneumonia has also changed, underscoring the necessity for educating clinical providers on typical presentations, diagnostic protocols, and treatment options for aspiration pneumonia.