Investigators from multiple institutions in Osaka, Japan, conducted a retrospective study to assess the relationship between food aspiration and/or saliva aspiration and pneumonia in children and young adults with severe motor disturbances and/or developmental delay. Patients who were receiving care for dysphagia at the Osaka Developmental Rehabilitation Center, Osaka, Japan, were enrolled in the study. Chest CT was performed to detect signs of aspiration pneumonia in study participants. CT scans were evaluated by 2 of the authors who used a standardized method to classify specific radiographic signs of aspiration pneumonia, including parenchymal bands, bronchiolectasis, bronchial wall thickening, bronchiectasis, atelectasis, tree-in-bud pattern, intraluminal airway debris, fibrosis, and air trapping. If any of these findings were present, the patient was classified as having pneumonia. Within 1 week of CT, study participants underwent fiberoptic endoscopic evaluation of swallowing (FEES). The presence of food and/or saliva aspiration was categorized using the penetration-aspiration scale (PAS); PAS scores of 5–6 were classified as aspiration, and scores of 1–4 were classified as no aspiration. Food aspiration and saliva aspiration were categorized separately. The primary outcome was pneumonia at CT. The secondary outcome was a history of pneumonia in the past year based on medical record review. The associations between food or saliva aspiration and these outcomes were assessed with chi-square tests.
Data were analyzed on 85 participants with a mean (standard deviation) age of 11.2 (7.2) years (range, 11 months to 26 years). All patients received nutrition orally, with 49.4% also receiving tube feedings. Among study participants, 48 (56.5%) had food aspiration, 26 (30.6%) had saliva aspiration, and 20 (23.5%) had both. Signs of pneumonia were found at CT in 34 (70.8%) patients with food aspiration compared to 20 (54.1%) patients with no food aspiration (P=.11). There was also no statistically significant association between food aspiration and a history of pneumonia in the previous year; 41.7% of those with food aspiration had a history of pneumonia compared to 35.1% of patients with no food aspiration (P=.55). However, among those with saliva aspiration, 88.5% had CT findings of pneumonia versus 52.5% of those without saliva aspiration (P=.002). There was no statistical association between saliva aspiration and a history of pneumonia.
The authors conclude that saliva aspiration may be an indicator of aspiration pneumonia risk in contrast to the presence of food aspiration at FEES.
Dr Bratton has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.
The relationship of aspiration to both acute and chronic pulmonary injury remains poorly understood. The concept that aspiration of food contents causes lung injury is based on the observation of respiratory distress and fever developing within hours after an...