Epidemiology

Aspiration can occur regardless of sex, age group, or ethnicity.[9] True incidence of aspiration pneumonia is difficult to assess because many cases of community-acquired pneumonia (CAP) or hospital-acquired pneumonia are likely the result of aspiration that was undiagnosed. However, some studies suggest that aspiration pneumonia may be the cause of as many as 5% to 15% of CAP cases.[10][11] It occurs most commonly in older hospitalized or nursing-home patients, especially those with swallowing dysfunction, impaired mental status, neurologic diseases, or mechanical impairment of the digestive tract.[4][9] It is the most common cause of death among patients with swallowing dysfunction related to neurologic disease.[8]

Risk factors

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altered mental status

Reduced level of consciousness may lead to an inadequate cough reflex and impaired glottal closure. Altered consciousness can be a result of alcohol, drugs, or anesthesia.[4][12][13][18]

swallowing dysfunction

Seen in neurologic conditions, in particular, especially stroke. As many as 40% to 70% of stroke patients have swallowing dysfunction and many of them have silent aspiration.[4][8][12][18]

gastrointestinal disease

Upper GI surgery and esophageal abnormalities predispose to aspiration.[12][13] Gastroesophageal reflux disease, hiatal hernia, other gastrointestinal motility disorders, and conditions that affect gastric emptying (obesity and pregnancy) increase the risk of regurgitation and pulmonary aspiration.[19]

intubation or tracheostomy tube

Aspiration of oropharyngeal bacteria can occur around the endotracheal tube, although this is typically called ventilator-associated pneumonia, rather than aspiration pneumonia.[20] Risk of aspiration may be especially high immediately after removal of the tube.[8]

older age

May be related to poor oral hygiene and swallowing dysfunction.[4][12][13][18]

feeding tube

Nasogastric or percutaneous feeding tubes have similar rates of aspiration pneumonia. May relate to impaired lower esophageal sphincter function.[8][12][13] Gastrostomy or jejunostomy tubes do not interfere with swallowing. To help deal with aspiration, gastrostomy tubes can be used but they do not resolve the problem of aspirating oral secretions.

recumbent position

May predispose to aspiration. Semi-recumbent position may be preferable.[22][23]

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chemoradiation for head and neck cancers

Aspiration commonly occurs after radiation. Risk factors for the subsequent development of pneumonia are tracheobronchial aspiration and a positive smoking history.[17]

poor oral hygiene

Leads to oropharyngeal colonization with respiratory pathogens.[8][21]

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