Aspiration is the process that occurs when secretions, food and other things taken orally are misdirected into the lungs and respiratory tree. This occurs from a number of physiologic and pathologic or disease processes that make the swallowing mechanism malfunction. The medical term that describes problems with swallowing is dysphagia. 'Dys' before a word means bad or malfunction. 'Phagia' is the medical term related to swallowing function. Thus, Dysphagia is difficulty swallowing.
The lungs cannot tolerate foods, medications, and bacteria-laden secretions from the mouth and nose. When the lungs experience these types of solutions, their first response is to cough. They want to clear these foreign items to prevent infection and inflammation.
If the cough is not robust enough to clear the foreign material or the amount of the foreign material is too great for the lungs to clear it, the lungs respond with inflammation and irritation. Inflammation is not an infection. Inflammation may be a precursor to infection because it is an irritation and it makes it easier for bacteria to set up an infection in the abnormal lung tissue that is no longer intact.
This condition of noninfection is called aspiration pneumonitis. Pneumonitis is inflammatory rather than infectious. The pneumonitis may become pneumonia if the body is not able to fight off the bacteria and foreign material that are now in the lungs.
The first sign of dysphagia is coughing when eating or drinking. As noted earlier, the lungs have a reflex to cough to clear themselves of foreign bodies or secretions. The cough is a sign of potential or actual aspiration. At that point, a speech therapist should be added to the team for assessment of the swallow function. There are a number of tests and monitoring that the speech therapist will use to assess the level of dysphagia. They will then provide recommendations to minimize the aspiration.
Exercises can be very beneficial. In cases when the exercises are not enough to prevent aspiration, the speech therapist may recommend changing the consistency of the diet. Liquids may need to be thickened, and foods may need to be alerted in consistency to minimize aspiration.
One of the best and easiest ways to prevent pneumonia is good oral care. The secretions from the mouth are bacteria laden. With proper oral care including brushing and mouthwash, the bacteria load can be minimized so that secretions are not so problematic. Observe as the senior eats their meals.
If they are coughing, sound gurgling as they swallow, cannot clear food from their mouth or pack their mouth with food rather than swallow, it is time for a speech therapist consult. Contact your healthcare provider or Charism for a referral. The options that are recommended by the speech therapist and the physician are guidelines, and the family will want to ask questions to understand the impact on quality of life for their loved one.