Ways Of Aspiration Pneumonia Prevention

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Title: Ways Of Aspiration Pneumonia Prevention
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Ways Of Aspiration Pneumonia Prevention

By Brian Wilson


Aspiration pneumonia is a common condition among patients on long term care. It occurs when a person inhales contents from their oropharynx or their stomach into the lower respiratory tract. Compared to the general population, persons who are on long term care are three times as likely to have this condition. We will look at some of the strategies that can be undertaken in aspiration pneumonia prevention.

The main factors that have been found to increase the risk of suffering the condition among patients in long term care include difficulty in swallowing (dysphagia), the use of certain medications among these patients and poor oral hygiene. Addressing these factors significantly helps to minimize the risk and reduce the morbidity associated with aspiration that include pneumonia, pneumonitis, abscess formation and obstruction. Pneumonia is likely to be encountered if the aspirated contents contain bacterial organisms.

About 15% of adults are believed to have difficulties in swallowing, dysphagia. This means that they are at a significantly high risk of aspiration. The incidence has been shown to increase with advancing age. The incidence of dysphagia is about 50% among patients that are 80 to 89 years. This is mainly brought about by the anatomical and physiological changes that occur as we advance in age. Other conditions that may also contribute include cerebral palsy, dementia, traumatic brain injury and stroke among others.

There are several interventions that can be undertaken as measures to help patients with dysphagia. Swallowing therapy is one of the most effective. In this form of therapy, the patient is taught to engage in certain maneuvers that will help reduce the risk of aspirating. Dietary modification is another intervention that can be considered. Lighter viscosity diet can be more easily aspirated than honey-like viscosity. The third option that can be tried is tube feeding.

A majority of long term care patients have been shown to have poor oral hygiene. In one study involving 260 patients, it was established that 70% of them had not been by a dentist in 5 years. Many of these patients may not be able to clean their own teeth which worsens the problem further. Providing assistance on teeth cleaning on a regular basis is one of the interventions that may be undertaken to reduce the incidence of aspiration.

Many of the patients who are on long term care tend to be on multiple medications some of which may hinder the swallowing function. It is important that all the drugs are evaluated before being administered. Some of the drugs that may increase the risk of aspiration include hypnotics, sedatives, antiemetics and muscle relaxants among others.

There are a number of drugs that can be used to reduce the chance of aspirating gastric or oropharyngeal contents. One of the drugs that has been shown to be beneficial is the drug levodopa. This drug works by increasing the levels of dopamine, an important chemical in the swallowing function (maintains the tome in muscles used for swallowing). Enalapril and other angiotensin converting enzyme inhibitor drugs also reduce the risk due to their ability to reduce oral secretions.

Aspiration pneumonia is associated with severe morbidity especially if treatment is delayed. Although treatments for the condition exist, there should be greater emphasis on prevention. The team that is involved in prevention include nurses, physicians, swallowing therapists and physiotherapists among others.




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