Aspiration is the inhalation of material from the back of the throat or stomach. We also need to include those instances where some type of foreign body is inhaled and gets into the lower respiratory tract. Many factors can be associated with aspiration but all usually include some type of swallowing disorder. Aspirations can be sudden or more chronic. Aspiration can lead to both short term and long term consequences. Aspiration is the most common cause of hospital acquired pneumonia and has a mortality rate of 20% to 65%. Most of these patients are elderly or seriously ill at the time of their aspiration making the problem even more complex, and potentially deadly.
Acute aspirations of larger foreign bodies often requires urgent attention. I have seen teeth, large chunks of food and even a bolt aspirated. These events are usually witnessed and focused attention is usually given. These patients often need a bronchoscopic procedure to remove the offending foreign body. The rigid bronchoscope, rather than the flexible type, is generally required, although, I have removed chunks of food with the flexible scope. Chronic aspiration may go unrecognized for some time and can result in long term damage to the lower respiratory tract. Chronic cough and the development of chronic lower lobe scarring can occur.
The diagnosis begins with a high index of suspicion and this is then followed by appropriate testing to determine if the swallowing mechanism of the patient is intact. Treatment can be difficult since there are no medical therapies.