Get a SALT! He’s aspirating!!!

Does it matter if a person aspirates? Yes. And No. Well, sometimes. It depends. It’s a bit complicated…

Aspiration

Firstly, what is aspiration?

One of the ways that Speech and Language Therapists measure aspiration is by using the Penetration-Aspiration Scale (PAS). It looks like this.

So it’s basically a 6, 7 or 8 on the PAS.

So it’s not just food and drink that can be aspirated?

Nope!

Here are some surprising stats for you:

  • Did you know that just under 50% of people without dysphagia aspirate their saliva all night?!
  • And in one study, 28.0% to 35.7% of asymptomatic healthy older adults had intermittent trace aspiration of liquids during flexible endoscopic evaluation of swallowing.
  • The pneumonia incidence in some of the most vulnerable adults is just 11-20%.

So, if you’re aspirating but not getting pneumonia, does that mean aspiration doesn’t always lead to pneumonia? And you can aspirate without dysphagia? And what else can you aspirate?

Lots of questions.

What else can you aspirate?

Even without dysphagia, it’s possible to aspirate;

  • food
  • drink
  • saliva
  • sputum
  • vomit
  • blood
  • acid (reflux)
  • objects (kids like swallowing small toys!)

Aspiration Pneumonia

When the aspirated material lands on the lungs, it can cause pneumonia. There are two types of aspiration pneumonia.

DAP – Dysphagia-related Aspiration Pnuemonia

This happens because of oropharyngeal dysphagia (a swallow problem in the mouth or throat). It needs the following;

  • A pathogen in solid or liquid matter
  • Travels down by gravity to its destination
  • It’s not airborne, nor is it an inhaled pathogen
  • It can occur anywhere in the lungs

NDAP – Non dysphagia-related Aspiration Pneumonia

This is oesophago-gastric aspiration. It’s because of reflux or vomiting.

Does aspiration cause pneumonia?

No, not necessarily.

It is generally regarded as needing THREE things to result in pneumonia.

Dr John Ashford calls this the Three Pillars.

https://www.sasspllc.com/three-pillars-pneumonia/

As you can see, it often takes more than simply aspirating food or drink particles for it to become an aspiration pneumonia.

Oral health is a big deal in PREVENTING aspiration pneumonia as well as treating underlying health conditions and dysphagia.

We recommend our friends over at Knowledge Oral Healthcare for further training on mouth care. Makes such a difference!

Predicting Aspiration Pneumonia

In Langmore’s study, she found that, “Documented aspiration of food or liquid on an
instrumental swallow study were not significant predictors of pneumonia.” So what is?

The study authors created a model of significant predictors that are positioned where they are thought to impact colonization and aspiration that can lead to pneumonia.

Summary

It takes a few things to result in aspiration pneumonia. But aspiration alone isn’t the issue.

To prevent the people you care for from getting aspiration pneumonia, it takes;

  • regular and thorough mouth care
  • optimised treatment of underlying health conditions
  • swallow therapy for greater efficiency of the swallow if dysphagia is present (this reduces the likelihood of aspiration and is preferable to compensatory measures alone – like texture modified food and drink)

References

  1. Ashford, J.R., 2005. Pneumonia: Factors Beyond Aspiration. Perspect Swal Swal Dis (Dysph) 14, 10–16. https://doi.org/10.1044/sasd14.1.10
  2. Bock JM, Varadarajan V, Brawley MC, Blumin JH. 2017. Evaluation of the natural history of patients who aspirate. Laryngoscope. Dec;127 Suppl 8(Suppl 8):S1-S10
  3. Huxley EJ, Viroslav J, Gray WR, Pierce AK. Pharyngeal aspiration in normal adults and patients with depressed consciousness. Am J Med. 1978 Apr;64(4):564-8. doi: 10.1016/0002-9343(78)90574-0. PMID: 645722.
  4. Langmore, S.E., Terpenning, M.S., Schork, A., Chen, Y., Murray, J.T., Lopatin, D., Loesche, W.J., 1998. Predictors of Aspiration Pneumonia: How Important Is Dysphagia? Dysphagia 13, 69–81. https://doi.org/10.1007/PL00009559
  5. Logemann Jeri A., Gensler Gary, Robbins JoAnne, Lindblad Anne S., Brandt Diane, Hind Jacqueline A., Kosek Steven, Dikeman Karen, Kazandjian Marta, Gramigna Gary D., Lundy Donna, McGarvey-Toler Susan, Miller Gardner Patricia J., 2008. A Randomized Study of Three Interventions for Aspiration of Thin Liquids in Patients With Dementia or Parkinson’s Disease. Journal of Speech, Language, and Hearing Research 51, 173–183. https://doi.org/10.1044/1092-4388(2008/013)
  6. O’Keeffe, S.T., 2018. Use of modified diets to prevent aspiration in oropharyngeal dysphagia: is current practice justified? BMC Geriatr 18, 167. https://doi.org/10.1186/s12877-018-0839-7
  7. Rosenbek, J.C., Robbins, J.A., Roecker, E.B., Coyle, J.L., Wood, J.L., 1996. A penetration-aspiration scale. Dysphagia 11, 93–98. https://doi.org/10.1007/BF00417897
  8. Todd, J.T., Stuart, A., Lintzenich, C.R., Wallin, J., Grace-Martin, K., Butler, S.G., 2013. Stability of aspiration status in healthy adults. Ann Otol Rhinol Laryngol 122, 289–293. https://doi.org/10.1177/000348941312200501

Published by Sandra Robinson

Independent Speech and Language Therapist. Specialist Dysphagia Practitioner.

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