Pharmacological Approach Based on Substance P Theory: Does the Substance P Play a Central Role in Pathogenesis of Dysphagia in Aspiration Pneumonia?

  • Seiichi KobayashiEmail author
  • Masaru Yanai
Part of the Respiratory Disease Series: Diagnostic Tools and Disease Managements book series (RDSDTDM)


Aspiration pneumonia is the common cause of death in the elderly that is associated with decreases in both swallowing and cough reflexes. Basal ganglia infarctions predispose these patients to develop pneumonia due to silent aspiration during sleep. Both reflexes are mediated by endogenous substance P released from vagal sensory nerves. Angiotensin-converting enzyme (ACE) inhibitors suppress degradation of substance P and improve both swallowing and cough reflexes. ACE inhibitors can reduce the risk of aspiration pneumonia in selected patients with stroke, particularly in Asian patients. Cilostazol, an antiplatelet agent, is reported to reduce pneumonia in patients with a history of stroke. Banxia Houpo Tang (BHT, Hange-koboku-to in Japanese), a Chinese herbal (Kampo) medicine, can improve the swallowing and cough reflex in the elderly with a history of pneumonia and have beneficial effects on prevention of pneumonia. Antipsychotics can cause impairment of swallowing reflex due to dopamine blocking activity; therefore, antipsychotics should be avoided in elderly patients. We propose to consider pharmacological approach based on substance P theory to the proper subjects.


Angiotensin-converting enzyme inhibitors Aspiration pneumonia Cough reflex Substance P Swallowing reflex 


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Copyright information

© Springer Nature Singapore Pte Ltd. 2020

Authors and Affiliations

  1. 1.Department of Respiratory MedicineJapanese Red Cross Ishinomaki HospitalIshinomakiJapan

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