History and exam
Key diagnostic factors
common
presence of risk factors
Ask about risk factors for aspiration pneumonia. However, bear in mind that many patients with pneumonia, even if they have risk factors for aspiration such as swallowing dysfunction, will have a community-acquired, rather than aspiration, pneumonia.[67] Risk factors can be classified according to the underlying mechanism, which can cause aspiration pneumonia due to:
Aspiration of oral secretions:
Swallowing dysfunction (e.g., stroke, dementia, epilepsy, multiple sclerosis, Parkinson’s disease, motor neuron disease)
Impaired conscious level
General anaesthetic or oropharyngeal procedures
Gastrointestinal (GI) disease (e.g., upper GI surgery, hiatal hernia) and conditions that affect gastric emptying (e.g., obesity, pregnancy)
Poor cough (e.g., upper airway problems such as pharyngeal pouches and vocal cord palsies, neuromuscular disease)
Aspiration pneumonia is a poor prognostic sign in patients with neuromuscular disease[8]
Poor oral hygiene
Reflux/vomiting:
General anaesthetic or oropharyngeal procedures
Poor oral hygiene
Recumbent position during enteral feeding
Polytrauma
Head and neck cancers.
cough
Non-specific symptom. May be present for a week or more after the event.
breathlessness
Non-specific symptom. May be present for a week or more after the event.
Other diagnostic factors
common
history of vomiting
Clinical history is especially important because witnessed aspiration is not seen in the majority of patients.
tachypnoea
Non-specific symptom. Should raise the suspicion for aspiration pneumonia.
foul-smelling breath
Associated with presence of anaerobic bacteria. Highly variable finding in patients with aspiration pneumonia.
crepitations
Highly variable finding in patients with aspiration pneumonia.
frothy or purulent sputum
Non-specific symptom. Should raise the suspicion for aspiration pneumonia.
uncommon
fever
Non-specific symptom. Should raise the suspicion for aspiration pneumonia.
pleuritic chest pain
Non-specific symptom. May be present for a week or more after the event.
delirium
Non-specific symptom. Should raise the suspicion for aspiration pneumonia.
reduced appetite
Non-specific symptom. Should raise the suspicion for aspiration pneumonia.
reduced mobility
Non-specific symptom. Should raise the suspicion for aspiration pneumonia.
general debilitation
Non-specific symptom. Should raise the suspicion for aspiration pneumonia.
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