What Is Aspiration?
[MUSIC PLAYING]
JOHN WHYTE: Hello.
I'm Dr. John Whyte, the Chief
Medical Officer for WebMD.
You've probably heard of RSV,
Respiratory Syncytial Virus.
It's been in the news a lot
lately, and you may be wondering
what the big deal is.
For most people, the symptoms
are mild, but it is a highly
contagious virus.
And if you're an older adult
and have
certain underlying
health conditions,
it's important to take
RSV seriously.
With me today is Dr. Morgan
Katz, an infectious disease
specialist from Johns
Hopkins Medicine,
to talk about what RSV is
and how it might affect you.
Dr. Katz, thanks for joining me.
MORGAN KATZ: Thank you so
much for having me.
JOHN WHYTE: Let's start off
with what are the symptoms
of RSV
that people should be aware of?
MORGAN KATZ: So the symptoms
of RSV can really vary depending
on the individual.
In the majority
of healthy children and adults,
RSV is going to cause symptoms
similar to any common cold.
So nasal congestion, some cough,
sore throat, sometimes a fever.
However, in the extremes of age,
so in infants and older adults--
and that is really adults
over the age of 60
with other chronic medical
conditions and really adults
over the age of 75 --you're
going to see more
severe symptoms.
In infants, we can see something
called bronchiolitis, which
is inflammation
of the small airways
of the lung, or pneumonia, which
causes wheezing,
difficulty breathing,
and sometimes needing
respiratory support.
In older adults,
you can see other issues more
like severe pneumonia, fever,
and potentially, what we're
starting to learn, other issues
down the road after
RSV infection
such as cardiac complications.
So this really is a disease that
can have significant impact
on infants, older adults,
and otherwise, you're going
to see, generally, pretty mild
symptoms of a common cold
in healthy kids
and healthy adults.
JOHN WHYTE: How is
RSV different
than other common viruses
like the cold or the flu?
MORGAN KATZ: So that's
a great question, and honestly,
it's pretty hard to tell.
And I think we are starting
to identify and talk about RSV
a little bit more
now in light of the
COVID-19 pandemic.
We're testing ourselves
more often.
We're more eager to diagnose
exactly what's going on.
We have a better understanding
now of how severe RSV can be,
particularly in older adults.
We've understood for a while
that RSV can cause quite
severe disease in infants,
but now we're understanding
a little bit more
that RSV can cause
severe pneumonia,
other complications,
even death in older adults.
JOHN WHYTE: Are there
any special precautions people
should take to avoid getting
or spreading RSV?
MORGAN KATZ: We do now have
new prevention strategies,
vaccines available for RSV.
There are currently three FDA
approved vaccines in the
United States.
It's recommended by the CDC
for all adults over the age
of 75 and adults over the age
of 60
that may be at risk
for severe disease.
We also have-- some
are core infection
prevention practices
that we can use to
prevent transmission
of respiratory viruses.
So things like staying home when
you're sick,
hand hygiene, wearing a mask--
all those things can help
prevent being exposed
to this virus and transmission
of the virus.
Of course, in nursing homes
and congregate living
facilities, transmission
of respiratory viruses
can happen very quickly.
You have to understand that you
have a whole lot
of vulnerable individuals living
in one setting who are generally
dependent on staff, health
care, direct caregivers
to provide direct care,
which can also lead
to transmission of some
of these respiratory viruses.
So we can see
these viruses sweep
through congregate
living facilities
and cause major problems
in this vulnerable population.
JOHN WHYTE: Dr. Katz, thank you
for sharing
this important information
with us.
MORGAN KATZ: Thank you.
Thank you for having me.
[MUSIC PLAYING]
Aspiration is when something you swallow "goes down the wrong way" and enters your airway (trachea or windpipe) or lungs. It can also happen when something goes back into your throat from your stomach. With aspiration, your airway isn’t completely blocked, unlike with choking.
People who have a hard time swallowing are more likely to aspirate. Up to 15 million Americans have trouble swallowing, called dysphagia. It can be temporary or part of a more serious condition.
People who might aspirate often or have problems swallowing include those who are older adults, who have had a stroke, and who have developmental disabilities.
Aspiration Symptoms
Sometimes, there’s no clear sign that food or liquid is going down the wrong way. Because you don't notice it, you don't cough. But in most cases, you:
- Feel something stuck in your throat
- Have pain when you swallow, or swallowing is hard
- Cough while or after you eat or drink
- Feel congested after you eat or drink
- Have a gurgling or "wet-sounding" voice when you eat
Other signs are:
- Too much saliva in your mouth
- Chest discomfort or heartburn
- Shortness of breath or fatigue while eating
- Fever within a half-hour of eating
- Frequent pneumonia
- Trouble chewing
What Causes Aspiration?
Your chances of aspiration go up with age, since you may have more trouble chewing and swallowing as you get older.
Other things that can cause you to aspirate are:
- Seizures
- Fatigue
- Acid reflux
- A loss of mental ability
- A loss of muscle tone or coordination that interferes with how well you chew or swallow
- A reaction to medication
- Throat cancer
- Head and neck injuries
- A stroke
- Nervous system disorders like amyotrophic lateral sclerosis (ALS), Parkinson's disease, and multiple sclerosis
- Eating or drinking too fast
- Dental problems
- Mouth sores
- Radiation or chemotherapy for your throat or neck
- Frequent vomiting
- Breathing machines or feeding tubes
- Intracranial tumors
- Gastroesophageal reflux disease (GERD)
Silent Aspiration
Silent aspiration happens when you inhale a liquid, beverage, or other item into your airway without knowing. You may not have symptoms with it, and usually your body clears out the liquid or other material by coughing. If you just inhale a small amount, it's not a concern. But if you have silent aspiration regularly, you could get more serious conditions like aspiration pneumonia (a lung infection).
Silent aspiration differs from overt aspiration in that you can inhale things without noticing. With overt aspiration, you have abrupt and noticeable symptoms.
Signs and symptoms of silent aspiration
If you or your baby has silent aspiration, you may not have any symptoms. But some symptoms in babies can be:
- Holding their breath or breathing faster while eating
- Unwilling to be fed, turning away during feedings
- Having a wet-sounding cry or voice after being fed
- Having repeated low-grade fevers or infections, including in the lungs
Adults may have slightly different symptoms, like:
- Faster breathing while eating
- Congestion in the nose that goes away after eating
- Wheezing or noisy breathing
- Feeling that something is stuck in your throat
- A buildup of mucus that affects your voice (wet sound)
- Frequent infections
Aspiration in Children
Some children have trouble swallowing because of throat muscle problems caused by:
- Physical conditions such as a cleft palate
- Delayed growth
- Brain damage
- Nerve problems
- Muscle diseases like spinal muscular atrophy
Common symptoms of aspiration in babies and children are similar to those of silent aspiration and can include:
- Weak sucking
- A red face, watery eyes, or grimacing while feeding
- Breathing that speeds up or stops while feeding
- A slight fever after feeding
- Breathing problems like wheezing
- Frequent lung or airway infections
Aspiration Diagnosis
Your doctor will ask about your symptoms and do a physical exam. They might look closely at your mouth and cheeks. They may also recommend that you see a specialist called a speech-language pathologist, who can check for problems with your swallowing muscles.
You might have tests such as:
- X-rays. These can give your doctor an image of how much material you’ve breathed in.
- Bronchoscopy. Your doctor gives you medicine to relax and puts a thin tube called a bronchoscope down your throat. It has a tiny camera to take images of the insides of your lungs.
- Modified barium swallow (MBS). A technician takes X-rays of your throat and esophagus while you swallow foods and liquids that have been mixed with a chemical called barium.
- Fiber-optic endoscopic evaluation of swallowing (FEES). A specialist numbs your nose. They put a thin, flexible tube called an endoscope through it and into your throat. A camera inside it takes pictures while you swallow saliva, food, and liquids.
- Pharyngeal manometry. With your nose numbed, a technician puts a tube called a catheter through it and into your throat. The catheter has sensors to measure the pressure in your throat and esophagus when you swallow.
Aspiration Treatment
Treatment for aspiration begins with treating the condition that's causing it.
If you have dysphagia, treatment options vary, depending on the type:
- Oropharyngeal dysphagia can be treated with learning exercises and swallowing methods. These can help with proper swallowing muscle movement and nerves that control the swallowing reflex. If you have a neurological condition, swallowing techniques like proper placement of your head and body while swallowing can help.
- Esophageal dysphagia treatments can include dilation, which involves placing a tube from your throat to your stomach and stretching your esophagus, medications that can reduce stomach acid (for conditions like GERD), surgery to clear the path leading to your esophagus, or a prescription for a special diet.
- Severe dysphagia. If your problems are more severe, your doctor may recommend insertion of a feeding tube so that you can get nutrients without swallowing. Surgery to help with blockages or narrowing of the throat can also be treatment options. Swallowing and speech therapy may be recommended after these procedures.
Babies who aspirate their breast milk or formula a lot may need a change in diet that includes thickened feeds. In severe cases of aspiration, your baby may need a temporary feeding tube inserted into their nose or belly. Usually, your doctor can remove the tube when your baby is better able to swallow.
Aspiration Pneumonia
Aspiration pneumonia is a lung infection caused by food, liquid, or objects being inhaled into your lungs that causes inflammation and buildup of fluid. Symptoms may come on slowly. Without treatment, they can become dangerous.
Aspiration pneumonia symptoms
Signs of aspiration pneumonia include:
- Frequent coughing with smelly mucus , blood, or pus
- Wheezing or shortness of breath
- Fever or chills and severe sweating
- Chest pain when you cough or take a deep breath
- Confusion, anxiety, and fatigue
- Feeling of suffocation
- Bad breath
Aspiration pneumonia treatment
Treatment for aspiration pneumonia includes:
- Antibiotics. Antibiotics for aspiration pneumonia are the main form of treatment but can depend on where you got pneumonia from and any allergies to medication (like penicillin).
- Oxygen therapy. Because aspiration can cause breathing trouble, extra oxygen may be needed.
- Mechanical ventilation. During this treatment, a machine is breathing for you.
Other Complications of Aspiration
Aspiration can lead to more severe issues, like infection and tissue damage.
Over time, aspiration can also lead to dehydration, malnutrition, and weight loss, as well as higher chances of other illnesses.
Aspiration Prevention
Try these tips to avoid aspiration when you swallow:
- Eat only when you're alert and relaxed.
- Cut your food into small pieces.
- Eat smaller meals, and eat more often.
- Add moisture, like sauce, to dry food.
- Always swallow before you take another bite.
- Avoid foods that stick together.
- Don't talk while you eat or drink.
- Don’t eat or drink while lying flat.
- Use good posture while eating.
- Take care of your mouth and teeth. See your dentist regularly.
- Don’t smoke.
- Take your time when you're eating or drinking.
- Avoid heavy, fried food 3 hours before you rest (to prevent acid reflux).
Takeaways
When you inhale food, a drink, or a small object and it "goes down the wrong pipe," be sure to check your symptoms. Talk to your doctor if you have a constant feeling that something is stuck in your throat. If left untreated, aspiration or silent aspiration can lead to complications like aspiration pneumonia.
Aspiration FAQs
What happens when a person aspirates? When you aspirate, food, drink, or small objects you've inhaled go into the airway or lungs instead of your stomach. Usually, nerves and muscles in your throat and mouth keep food out of your lungs.
How do I know if I aspirated food into my lungs? You will have certain symptoms if you aspirated, like pain when you swallow, coughing while or after you eat or drink, or feeling congested during these activities. If you have silent aspiration, you may not have any symptoms.
Is aspiration the same as choking? With aspiration, you inhale food, liquid, or objects into your airway or lungs. When you choke, your airway is blocked by these things. Aspiration can happen while you're choking, but it may be silent.
How long does aspiration pneumonia take to develop? Aspiration symptoms start a few hours after you inhale something and can take 1 to 2 days to develop into aspiration pneumonia.
