Emerging treatments

Angiotensin-converting enzyme (ACE) inhibitors

ACE inhibitors have been extensively studied to determine whether they can improve symptomatic dysphagia in patients at high risk of aspiration, such as those with a history of stroke or those who are tube-fed. In post-stroke patients, ACE inhibitors have been shown to reduce pneumonia risk more effectively than other antihypertensives.[46][47] A systematic review and meta-analysis found that ACE inhibitors were associated with a slightly lower risk of pneumonia compared with no ACE inhibitor treatment in adult patients; but the effect was small.[48]

Cilostazol

Cilostazol is a cyclic adenosine monophosphate phosphodiesterase inhibitor that inhibits platelet aggregation and is a direct arterial vasodilator. In patients treated with cilostazol for stroke, there was a reduction in secondary stroke and a reduction in aspiration pneumonia.[49][50]

Sensory stimuli

Capsaicin, menthol, and/or black pepper oil may be a low-risk approach to stimulate swallowing and cough reflexes.[35][51]

Other treatments

Amantadine, cabergoline, theophylline, capsiate, mosapride, and nicergoline have all been studied in aspiration pneumonia and have demonstrated promising results, especially in post-stroke studies carried out in Japan.[34][52][53][54][55][56] One study of metoclopramide used within 7 days of stroke in patients fed with a nasogastric tube showed reduced rates of pneumonia compared with placebo.[57]

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