Aspiration can lead to pneumonia and other serious complications.

We all know that pneumonia can develop after a person has been exposed to certain germs. But there’s another form of pneumonia that is far lesser known but that can also be deadly. It usually results when food being swallowed goes into the trachea (windpipe) instead of the esophagus (food pipe). Then, the food (or liquid, mucus or foreign substance) is aspirated — inhaled into the lungs.

Aspiration pneumonia occurs most often in adults age 65 and older. Like other types of pneumonia, it can cause symptoms such as a wracking cough (often accompanied by green or yellow foul-smelling phlegm)… fever… shortness of breath… wheezing… chest pain… and/or difficulty breathing.

Up to 15% of so-called community-acquired pneumonia is caused by aspiration, according to research in the New England Journal of Medicine. Also, the fatality rate for hospital-acquired pneumonia from aspiration can reach 25%.

Another danger: If a person aspirates a large object (or a mouthful of food), it can obstruct a major airway even if it makes it past the opening at the back of the throat. This may interfere with breathing and even cause a lung to collapse.

WHO IS AT RISK?

It’s fairly common for food and liquid to be aspirated, but lung specialists and emergency teams have found everything from dentures and tooth fillings to thumbtacks and batteries in patients’ lungs. These are typically spotted and removed using a bronchoscope viewing instrument and “grabber” device or, in rare cases, with surgery.

What most people don’t realize, however, is that material from their own bodies, particularly stomach contents, can be aspirated and can be equally dangerous.

Nearly half of healthy adults aspirate small amounts of contents from the stomach while they sleep. Most never experience symptoms because the amount of aspirated material is small and the body’s defenses (such as coughing) are strong enough to remove the material.

The aspiration of larger amounts of material is much more dangerous. It’s among the most feared complications of anesthesia — and the reason that patients are usually asked to fast for at least six to eight hours before having deep sedation.

Patients in intensive care units (ICUs) have a high risk for aspiration. So do those who have suffered a stroke or have dementia or a neuromuscular disorder, such as Parkinson’s disease. Anything that impairs consciousness or muscular control, including the use of sedatives or heavy alcohol consumption, increases the risk.

In healthy adults, aspiration may occur with certain types of foods, such as popcorn or peanuts, because people tend to toss these to the back of the mouth.

Common scenario: A man is popping food into his mouth without thinking about it, while reclining (increasing his risk for aspiration) in his favorite chair and watching TV. He’s also not chewing thoroughly. Suddenly, he may cough or choke and possibly aspirate pieces of food.

DANGEROUS INFLAMMATION

Patients who aspirate food, foreign objects, or vomit or other secretions can develop lung irritation and inflammation without infection. Damage to the lungs can impair the normal exchange of oxygen and carbon dioxide. If the object/material isn’t removed quickly, some patients may experience irreversible destruction of lung tissue.

Possible tip-offs that something has been aspirated include repeat pneumonia in the same area of the lung despite having taken antibiotics, a history of choking or, in older adults, possibly even missing dentures.

I once had a patient who aspirated a pill (in this case, an iron supplement). The supplement lodged in the lung for months and released corrosive chemicals that destroyed the surrounding lung tissue and caused large amounts of scar tissue.

EASY WAYS TO STAY SAFE

Be careful while eating and drinking. Nearly everyone occasionally aspirates a small amount of food.

Red flag: If you frequently choke during meals, you are probably eating too quickly and/or have developed bad swallowing habits that need to be corrected. For example, you may need to…

  • Stop talking while you eat. Talking while you chew is risky in two ways. You’re not paying attention to the act of chewing and swallowing, and you are more likely to take a deep breath at the wrong time and suck particles of food into the airways.
  • Position a straw at the side of your mouth if you use a straw when drinking. Using a straw in this way reduces the risk that a jet of liquid will go straight to the back of the throat and then into the airways.
  • Use a thickening agent in beverages and runny foods if you have a neuromuscular disease, such as Parkinson’s disease, or some other condition that makes it difficult to swallow. Thin liquids are more likely to cause aspiration because they move so quickly through the mouth and throat. Products, including Resource ThickenUp Instant Food Thickener and Thick-It Instant Food Thickener, are available in pharmacies.
  • Lower your chin slightly when swallowing. This slows the passage of foods/liquids down the throat.
  • Don’t eat within two hours of bedtime. You’re more likely to aspirate stomach contents during sleep if you’ve recently had a meal. Helpful: You can use wood blocks underneath the head of your bed to raise it by two to four inches. The force of gravity makes it harder for stomach contents to move “upstream.”

In hospital patients, one of the best ways to prevent aspiration is to elevate the head of the bed to 30