Skip to main content
SpringerLink
Log in

Clinical Significance of Aspiration Pneumonia in All the Pneumonia Therapy: The Impact of Aspiration Pneumonia on the Therapeutic Approach for All Pneumonia

  • Chapter
  • First Online:
Aspiration Pneumonia

Abstract

Pneumonia is commonly seen in all ages, but the morbidity and mortality of pneumonia increase drastically with age. A large number of pneumonia patients are the elderly who also have a high risk of aspiration. Compared to patients with non-aspiration pneumonia, patients with aspiration pneumonia show poorer prognosis, not only in the short-term but also in the long-term. The pathophysiologies of aspiration, aspiration pneumonia, and elderly pneumonia overlap, and these are very close disease entities. In addition to proper diagnosis and treatment of pneumonia in the elderly and patients with aspiration risks and aspiration pneumonia, prophylactic approach and nutritional evaluation are also important for the management of these patients. As standard diagnostic criteria of aspiration pneumonia have not been established, diagnosis of aspiration pneumonia is usually made by compatible findings on chest radiography that shows infiltrative shadows and gravity-dependent lung segments with characteristic clinical history and risk factors for aspiration. Therapeutic approach for aspiration pneumonia is the combination of antimicrobials against causative pathogens of pneumonia, treating malnutrition and comorbid illnesses, rehabilitation and reevaluation of all medications. In addition to proper diagnosis and treatment, appropriate preventive strategies such as pneumococcal and influenza vaccinations and keeping good nutrition status are necessary for better prognosis not only in patients with aspiration pneumonia but in patients with aspiration risks.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Metlay JP, Waterer GW, Long AC, Anzueto A, Brozek J, Crothers K, et al. Diagnosis and treatment of adults with community-acquired pneumonia. An official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. 2019;200:e45–67.

    Article  PubMed  Google Scholar 

  2. Ochoa-Gondar O, Vila-Córcoles A, de Diego C, Arija V, Maxenchs M, Grive M, et al. The burden of community-acquired pneumonia in the elderly: the Spanish EVAN-65 study. BMC Public Health. 2008;8:222.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Teramoto S, Yamamoto H, Yamaguchi Y, Hanaoka Y, Ishii M, Hibi S, et al. Lower respiratory tract infection outcomes are predicted better by an age >80 years than by CURB 65. Eur Respir J. 2008;31:477–8.

    Article  CAS  PubMed  Google Scholar 

  4. Komiya K, Rubin BK, Kadota JI, Mukae H, Akaba T, Moro H, et al. Prognostic implications of aspiration pneumonia in patients with community acquired pneumonia: a systematic review with meta-analysis. Sci Rep. 2016;6:38097.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Teramoto S, Fukuchi Y, Sasaki H, Sato K, Sekizawa K, Matsuse T, et al. High incidence of aspiration pneumonia in community- and hospital-acquired pneumonia in hospitalized patients: a multicenter, prospective study in Japan. J Am Geriatr Soc. 2008;56:577–9.

    Article  PubMed  Google Scholar 

  6. Marrie TJ. Community-acquired pneumonia in the elderly. Chest. 2004;125:801–2.

    Article  Google Scholar 

  7. Riquelme R, Torres A, El-Ebiary M, de la Bellacasa JP, Estruch R, Mensa J, et al. Community-acquired pneumonia in the elderly: a multivariate analysis of risk and prognostic factors. Am J Respir Crit Care Med. 1997;156:1908–14.

    Article  CAS  PubMed  Google Scholar 

  8. Ramsey D, Smithard D, Kalra K. Silent aspiration: what do we know? Dysphagia. 2005;20:218–25.

    Article  PubMed  Google Scholar 

  9. Huxley EJ, Viroslav J, Gray WR, Pierce AK. Pharyngeal aspiration in normal adults and patients with depressed consciousness. Am J Med. 1978;64:564–8.

    Article  CAS  PubMed  Google Scholar 

  10. Gleeson K, Eggli DF, Maxwell SL. Quantitative aspiration during sleep in normal subjects. Chest. 1997;111:1266–72.

    Article  CAS  PubMed  Google Scholar 

  11. Mandell LA, Niederman MS. Aspiration pneumonia. N Engl J Med. 2019;380:651–63.

    Article  CAS  PubMed  Google Scholar 

  12. Pinargote H, Ramos JM, Zurita A, Portilla J. Clinical features and outcomes of aspiration pneumonia and non-aspiration pneumonia in octogenarians and nonagenarians admitted in a general internal medicine unit. Rev Esp Quimioter. 2015;28:310–3.

    PubMed  Google Scholar 

  13. Komiya K, Ishii H, Umeki K, Kawamura T, Okada F, Okabe E, et al. Computed tomography findings of aspiration pneumonia in 53 patients. Geriatr Gerontol Int. 2013;13:580–5.

    Article  PubMed  Google Scholar 

  14. Teramoto S, Yoshida K, Hizawa N. Update on the pathogenesis and management of pneumonia in the elderly-roles of aspiration pneumonia. Respir Investig. 2015;53:178–84.

    Article  PubMed  Google Scholar 

  15. Almirall J, Rofes L, Serra-Prat M, Icart R, Palomera E, Arreola V, Clavé P. Oropharyngeal dysphagia is a risk factor for community-acquired pneumonia in the elderly. Eur Respir J. 2013;41:923–8.

    Article  PubMed  Google Scholar 

  16. Terada K, Muro S, Ohara T, Kudo M, Ogawa E, Hoshino Y, et al. Abnormal swallowing reflex and COPD exacerbations. Chest. 2010;137:326–32.

    Article  PubMed  Google Scholar 

  17. Japanese Respiratory Society. Aspiration pneumonia. Respirology. 2009;14(Suppl 2):S59–64.

    Google Scholar 

  18. Taylor JK, Fleming GB, Singanayagam A, Hill AT, Chalmers JD. Risk factors for aspiration in community-acquired pneumonia: analysis of a hospitalized UK cohort. Am J Med. 2013;126:995–1001.

    Article  PubMed  Google Scholar 

  19. Komiya K, Ishii H, Umeki K, Mizunoe S, Okada F, Johkoh T, et al. Impact of aspiration pneumonia in patients with community-acquired pneumonia and healthcare-associated pneumonia: a multicenter retrospective cohort study. Respirology. 2013;18:514–21.

    Article  PubMed  Google Scholar 

  20. Herzig SJ, LaSalvia MT, Naidus E, Rothberg MB, Zhou W, Gurwitz JH, Marcantonio ER. Antipsychotics and the risk of aspiration pneumonia in individuals hospitalized for nonpsychiatric conditions: a cohort study. J Am Geriatr Soc. 2017;65:2580–6.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Hayashi M, Iwasaki T, Yamazaki Y, Takayasu H, Tateno H, Tazawa S, et al. Clinical features and outcomes of aspiration pneumonia compared with non-aspiration pneumonia: a retrospective cohort study. J Infect Chemother. 2014;20:436–42.

    Article  PubMed  Google Scholar 

  22. Teramoto S, Ishii T, Yamamoto H, Yamaguchi Y, Ouchi Y. Nasogastric tube feeding is a cause of aspiration pneumonia in ventilated patients. Eur Respir J. 2006;27:436–8.

    Article  CAS  PubMed  Google Scholar 

  23. Dennis MS, Lewis SC, Warlow C. Effect of timing and method of enteral tube feeding for dysphagic stroke patients (FOOD): a multicenter randomized controlled trial. Lancet. 2005;365:764–72.

    Article  CAS  PubMed  Google Scholar 

  24. Metheny NA, Meert KL, Clouse RE. Complications related to feeding tube placement. Curr Opin Gastroenterol. 2007;23:178–82.

    Article  PubMed  Google Scholar 

  25. van der Maarel-Wierink CD, Vanob-bergen JN, Bronkhorst EM, Schols JM, de Baat C. Meta-analysis of dysphagia and aspiration pneumonia in frail elders. J Dent Res. 2011;90:1398–404.

    Article  PubMed  Google Scholar 

  26. Noguchi S, Yatera K, Kato T, Chojin Y, Fujino Y, Akata K, et al. Impact of the number of aspiration risk factors on mortality and recurrence in community-onset pneumonia. Clin Interv Aging. 2017;12:2087–94.

    Article  PubMed  PubMed Central  Google Scholar 

  27. El-Solh AA, Pietrantoni C, Bhat A, Aquilina AT, Okada M, Grover V, Gifford N. Microbiology of severe aspiration pneumonia in institutionalized elderly. Am J Respir Crit Care Med. 2003;167:1650–4.

    Article  PubMed  Google Scholar 

  28. Chandra RK. Nutritional regulation of immunity and risk of infection in old age. Immunology. 1989;64:141–7.

    Google Scholar 

  29. Bassili HR, Dietel M. Effect of nutrition support on weaning patients off mechanical ventilators. J Parenter Enter Nutr. 1981;5:161–3.

    Article  CAS  Google Scholar 

  30. Reinhardt GF, Myscofski RD, Wilkens D, Dobrin PB, Mangan JE, Stannard RT. Incidence and mortality of hypoalbuminemic patients in hospitalized veterans. J Parenter Enter Nutr. 1980;4:357–9.

    Article  CAS  Google Scholar 

  31. Ishida T, Tachibana H, Ito A, Ikeda S, Furuta K, Nishiyama A, et al. Clinical characteristics of pneumonia in bedridden patients receiving home care: a 3-year prospective observational study. J Infect Chemother. 2015;21:587–91.

    Article  PubMed  Google Scholar 

  32. Akata K, Yatera K, Yamasaki K, Kawanami T, Naito K, Noguchi S, et al. The significance of oral streptococci in patients with pneumonia with risk factors for aspiration. The bacterial flora analysis of 16S ribosomal RNA gene using bronchoalveolar lavage fluid. BMC Pulm Med. 2016;16:79.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  33. Sekizawa K, Ujiie Y, Itabashi S, Sasaki H. Lack of cough reflex in aspiration pneumonia. Lancet. 1990;335:1228–9.

    Article  CAS  PubMed  Google Scholar 

  34. Nakazawa H, Sekizawa K, Ujiie Y, Sasaki H, Takishima T. Risk of aspiration pneumonia in the elderly. Chest. 1993;103:1636–7.

    Article  CAS  PubMed  Google Scholar 

  35. Newnham DM, Hamilton SJ. Sensitivity of the cough reflex in young and elderly subjects. Age Ageing. 1997;26:185–8.

    Article  CAS  PubMed  Google Scholar 

  36. Andersson P, Hallberg IR, Renvert S. Inter-rater reliability of an oral assessment guide for elderly patients residing in a rehabilitation ward. Spec Care Dentist. 2002;22:181–6.

    Article  PubMed  Google Scholar 

  37. Shiraishi A, Yoshimura Y, Wakabayashi H, Tsuji Y. Poor oral status is associated with rehabilitation outcome in older people. Geriatr Gerontol Int. 2017;17:598–604.

    Article  PubMed  Google Scholar 

  38. Noguchi S, Yatera K, Kato T, Chojin Y, Furuta N, Akata K, et al. Using oral health assessment to predict aspiration pneumonia in older adults. Gerodontology. 2018;35:110–6.

    Article  PubMed  Google Scholar 

  39. Quagliarello V, Ginter S, Han L, Van Ness P, Allore H, Tinetti M. Modifiable risk factors for nursing home-acquired pneumonia. Clin Infect Dis. 2005;40:1–6.

    Article  PubMed  Google Scholar 

  40. Bartlett JG, Gorbach SL, Finegold SM. The bacteriology of aspiration pneumonia. Am J Med. 1974;56:202–7.

    Article  CAS  PubMed  Google Scholar 

  41. Cesar L, Gonzalez C, Calia FM. Bacteriologic flora of aspiration-induced pulmonary infections. Arch Intern Med. 1975;135:711–4.

    Article  CAS  PubMed  Google Scholar 

  42. Noguchi S, Mukae H, Kawanami T, Yamasaki K, Fukuda K, Akata K, et al. Bacteriological assessment of healthcare-associated pneumonia using a clone library analysis. PLoS One. 2015;10:e0124697.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  43. Yamasaki K, Kawanami T, Yatera K, Noguchi S, Fukuda K, Akata K, et al. Significance of anaerobes and oral bacteria in community-acquired pneumonia. PLoS One. 2013;8:e63103.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Respiratory Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu City, Fukuoka, Japan

    Kazuhiro Yatera

  2. Second Department of Internal Medicine, Nagasaki University School of Medicine, Nagasaki, Japan

    Hiroshi Mukae

Authors
  1. Kazuhiro Yatera
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hiroshi Mukae
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hiroshi Mukae .

Editor information

Editors and Affiliations

  1. Department of Respiratory Medicine, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan

    Shinji Teramoto

  2. Respiratory Medicine & Infectious Diseases, Oita University Faculty of Medicine, Yufu, Oita, Japan

    Kosaku Komiya

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Singapore Pte Ltd.

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Yatera, K., Mukae, H. (2020). Clinical Significance of Aspiration Pneumonia in All the Pneumonia Therapy: The Impact of Aspiration Pneumonia on the Therapeutic Approach for All Pneumonia. In: Teramoto, S., Komiya, K. (eds) Aspiration Pneumonia. Respiratory Disease Series: Diagnostic Tools and Disease Managements. Springer, Singapore. https://doi.org/10.1007/978-981-15-4506-1_2

Download citation

  • DOI: https://doi.org/10.1007/978-981-15-4506-1_2

  • Published:

  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-15-4505-4

  • Online ISBN: 978-981-15-4506-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation