Aspiration pneumonia and pneumonitis presents from mildly ill to critically ill along with the signs and symptoms of septic shock and respiratory failure.

Physical Examination: The findings of the physical examination depend on the severity of the disease and the presence of complications. Aspiration pneumonia shows the following signs: fever, tachypnea, tachycardia, decrease in breath sounds, rales, hyporexia, and/or hypotension.

Host Factors: The decreased ability to protect the airway of the host results from previous cerebro-vascular accident (CVA), esophageal diseases, esophageal web, or if the patient is chronically fed by feeding tube.

Chemical pneumonia

The physical symptoms of this type of pneumonia range from tachypnea, tachycardia, wheezing or cyanosis.

Bacterial pneumonia

The clinical presentation of bacterial aspiration pneumonia includes nonspecific symptoms such as headache or nausea/vomiting, and weight loss. Fever, absence of rigors, chest pain, chills and cough with sputum are some of the other symptoms manifested by the patients [7].

• Fever

  However, the results indicated that dyspnea, fever, deterioration of general functioning, tachypnea and crepitation with auscultation are characteristics of some importance and that at least two or three characteristics should be present. [ncbi.nlm.nih.gov]

  Other symptoms that occur in isolation or in association are cough, fever, breathlessness, and wheezing [4, 5]. [ajronline.org]

  Specialty Emergency medicine, pulmonology Symptoms Fever, cough[1] Complications Lung abscess[1] Usual onset Elderly[2] Risk factors Decreased level of consciousness, problems with swallowing, alcoholism, tube feeding, poor oral health[1] Diagnostic method [en.wikipedia.org]

• Pain

  Clinical Manifestations of Aspiration Pneumonia RHONCI & Crackles over Affected Area (lower lobe) -Most common signs-cough, fever, chills, dyspnea, tachypnea, and pleuritic chest pain (pain on inspirations) (Pedi-retractions, nasal flaring, accessory [quizlet.com]

  Comfort Cool Tennis Elbow Braces - Elbow Wraps, Sleeves & Bands Finger - Thumb Supports Foot and Ankle Braces - Supports Foot Pain & Injury Hernia Aids and Support Hip Surgery and Injury Knee Braces & Support Orthopedic Back Cushions Orthopedic Pillows [activeforever.com]

  Abstract A 44-year-old woman with a history of von Hippel-Lindau (VHL) disease, a rare inherited neoplasia syndrome, presented acutely to hospital with a productive cough, symptoms of respiratory tract infection and odynophagia (painful swallowing). [ncbi.nlm.nih.gov]

  Two common complications are associated with aspiration pneumonia: Lung abscess: A lung abscess is a pus-filled cavity in the lungs that causes severe pain and difficulty breathing. [dummies.com]

• Fatigue

  We ask about general symptoms (anxious mood, depressed mood, fatigue, pain, and stress) regardless of condition. Last updated: January 31, 2019 [patientslikeme.com]

  The most common symptoms are Bluish tint of the skin Chest pain Coughing Fatigue Fever Gurgling Shortness of breath Wheezing Talk with your physician immediately if you notice any of these symptoms. [dummies.com]

  […] not alert (unconscious or semi-conscious) after a stroke or brain injury Problems with swallowing Symptoms may include any of the following: Chest pain Coughing up foul-smelling, greenish or dark phlegm (sputum), or phlegm that contains pus or blood Fatigue [nlm.nih.gov]

• Epilepsy

  Epilepsy. Coma. Critical illnesses and debilitated patients. Gastroesophageal reflux disease (GERD). Iatrogenic – anesthesia (general), bronchoscopy, endoscopy (upper gastrointestinal), intubation (nasogastric or endotracheal). tracheostomy. [healthhype.com]

  Folios 46-67: Essay on the most important diseases of China, continued fever, remittent fever, intermittent fever, ephemeral fever, small pox, measles, scarlatina, epilepsy, insanity, coup de soleil, bronchitis pleuritis and pneumonia, pthisis, dysentery [discovery.nationalarchives.gov.uk]

• Acutely Ill Patient

  However, clinicians are generally hesitant to subject acutely ill patients to the majority of these procedures. Accordingly, the diagnosis is typically based on clinical features. [pulmonologyadvisor.com]

• Cough

  The aspiration pneumonia probably had multifactorial etiology: dysphagia, abnormal cough reflex, colonization of the oropharynx by virulent bacteria, etc. No aspiration pneumonia occurred after medical treatment and rehabilitation had been started. [ncbi.nlm.nih.gov]

  People with COPD do have strong coughs, but as their immune system weakens with age, it becomes less able to fight off infection. [healthcommunities.com]

• Dyspnea

  However, the results indicated that dyspnea, fever, deterioration of general functioning, tachypnea and crepitation with auscultation are characteristics of some importance and that at least two or three characteristics should be present. [ncbi.nlm.nih.gov]

  View larger version (105K) Fig. 3A —Aspiration of tooth to right main bronchus in 43-year-old man with dyspnea and fever. [ajronline.org]

  Symptoms and Signs Symptoms and signs include Cough Fever Dyspnea Chest discomfort Chemical pneumonitis caused by gastric contents causes acute dyspnea with cough that is sometimes productive of pink frothy sputum, tachypnea, tachycardia, fever, diffuse [merckmanuals.com]

  Symptoms include cough and dyspnea. Diagnosis is based on clinical presentation and chest x-ray findings. Treatment and prognosis differ by aspirated substance. [msdmanuals.com]

• Tachypnea

  However, the results indicated that dyspnea, fever, deterioration of general functioning, tachypnea and crepitation with auscultation are characteristics of some importance and that at least two or three characteristics should be present. [ncbi.nlm.nih.gov]

  tachypnea, dyspnea, tachycardia). Mucus production is also increased, which can obstruct airflow and further decrease gas exchange. [quizlet.com]

  Both aspiration pneumonia and pneumonitis can present with the following: Fever or hypothermia Tachypnea Tachycardia Decreased breath sounds Dullness to percussion over areas of consolidation Rales Egophony and pectoriloquy Decreased breath sounds Pleural [web.archive.org]

  Signs and symptoms Findings of aspiration may include one or several of the following: dyspnea, tachypnea, low oxygen saturation (O2 sat), putrid expectoration, malaise, and frequent coughing. [americannursetoday.com]

• Painful Cough

  The most common symptoms are Bluish tint of the skin Chest pain Coughing Fatigue Fever Gurgling Shortness of breath Wheezing Talk with your physician immediately if you notice any of these symptoms. [dummies.com]

  […] put you into a deep sleep for surgery ( general anesthesia ) Old age Poor gag reflex in people who are not alert (unconscious or semi-conscious) after a stroke or brain injury Problems with swallowing Symptoms may include any of the following: Chest pain [nlm.nih.gov]

  Coughing up foul-smelling, greenish or dark phlegm (sputum), or phlegm that contains pus or blood Fatigue Fever Shortness of breath Wheezing Breath odor Excessive sweating Problems swallowing Confusion The health care provider will listen for crackles [medlineplus.gov]

• Hemoptysis

  Aspiration may be clinically silent, or patients may develop life-threatening hemoptysis as a result [1]. The diagnosis of foreign body aspiration may not be obvious when a patient does not remember an episode of aspiration. [ajronline.org]

  Pink-colored to red sputum (hemoptysis) Bluish tinge of the lips, fingers and/or toes (cyanosis) Causes Aspiration pneumonia is unlikely to arise in a healthy person who is conscious and has properly functioning gag and cough reflexes. [healthhype.com]

  Half of patients report expectoration of putrid sputum that may or may not be associated with hemoptysis. These patients appear chronically ill and have fevers generally below 39 C. [pulmonologyadvisor.com]

  […] to aspiration.[1] It occurs more often in older people, especially those in nursing homes.[2] Both sexes are equally affected.[2] Signs and symptoms[edit] The person may have an insidious course with increased respiratory rate, foul-smelling sputum, hemoptysis [en.wikipedia.org]

  Chapter 81: Delirium -- Chapter 82: Diarrhea -- Chapter 83: Disorders of the Eye -- Chapter 84: Dizziness and Vertigo -- Chapter 85: Dyspnea -- Chapter 86: Edema -- Chapter 87: Falls -- Chapter 88: Fever and Rash -- Chapter 89: Headache -- Chapter 90: Hemoptysis [worldcat.org]

• Vomiting

  A washout period should be considered when switching between ChE inhibitors to minimize the risk of vomiting and aspiration. [ncbi.nlm.nih.gov]

  Inhalation of vomit can occur when a person who vomits is not completely awake, as can happen after a seizure or a drug or alcohol overdose or when a person awakens from anesthesia. [msdmanuals.com]

  Sometimes foods, liquids, or vomited stomach contents may accidentally get into these airways. Inhaling can move these substances further into the lungs. This is called aspiration. [health.cvs.com]

• Choking

  This study aimed to determine the frequency of reporting of AP or choking as a cause of death on death certificates with mention of stroke in the United States as a proxy measure of the incidence of dying from AP or choking among patients with stroke. [ncbi.nlm.nih.gov]

  Choking[edit] After falls, choking on food presents as the second highest cause of preventable death in aged care.[28] Although food choking risk is commonly associated with young children, data shows that individuals over 65 years of age have a choking [en.wikipedia.org]

• Nausea

  Cholinesterase (ChE) inhibitors approved for treatment of Alzheimer disease are associated with nausea and vomiting in a sizable percentage of patients, ranging from 5% to 31% in clinical trials. [ncbi.nlm.nih.gov]

  […] pneumonia is similar to that of community-acquired pneumonia and may include the following: Cough Fever or chills Malaise, myalgias Shortness of breath, dyspnea on exertion Pleuritic chest pain Putrid expectoration Nonspecific symptoms including headache, nausea [web.archive.org]

  Presentation Nonspecific symptoms - eg, fever, headache, nausea, vomiting, anorexia, myalgia, weight loss. Cough. Dyspnoea. Pleuritic chest pain. Purulent sputum. [patient.info]

  Bacterial pneumonia The clinical presentation of bacterial aspiration pneumonia includes nonspecific symptoms such as headache or nausea/vomiting, and weight loss. [symptoma.com]

• Loss of Appetite

  […] of appetite Coughing, with or without phlegm Your Legal Rights Since the elderly population has an increased risk of developing aspiration pneumonia, many victims and loved ones might not understand that they have legal recourse and write it off as a [medmalfirm.com]

  […] thick yellow, green, brown or blood-stained mucus (phlegm) difficulty breathing – your breathing may be rapid and shallow, and you may feel breathless, even when resting rapid heartbeat high temperature feeling generally unwell sweating and shivering loss [nhs.uk]

• Abdominal Pain

  Aside from the potential side effects of metronidazole, such as abdominal pain, pancreatitis or, more rarely, neurotoxicity,16 indiscriminate use may promote antibiotic-resistant flora. [mja.com.au]

  Language Options Pneumonia P Pneumonia Pneumonia English Respiratory Child (0-12 years);Teen (13-18 years) Lungs Lungs Conditions and diseases Caregivers Adult (19 ) Abdominal pain;Cough;Fever;Vomiting 2013-11-28T05:00:00Z Elly Berger, BA, MD, FRCPC, [aboutkidshealth.ca]

  that pain isn't always completely localized, and that a wide variety of conditions present with acute abdominal pain. [levinlaw.com]

  pain Pharyngolaryngeal pain Abdominal discomfort Flatulence Hypoesthesia lips Salivary hypersecretion Dyspepsia Dry mouth Pruritus ani Last Update: 2012-04-10 Usage Frequency: 2 Quality: Maltese Għall- pazjenti b’ HIV- HCV li qed jirċievu terapija kombinata [mymemory.translated.net]

  Pain -- Chapter 76: Acute Back Pain -- Chapter 77: Evaluation of Anemia -- Chapter 78: Bleeding and Coagulopathy -- Chapter 79: Chest Pain -- Chapter 80: Constipation -- Chapter 81: Delirium -- Chapter 82: Diarrhea -- Chapter 83: Disorders of the Eye [worldcat.org]

• Periodontitis

  The NHANES III data demonstrate that dental caries and periodontal diseases occur with substantial frequency and represent a burden of unmet treatment need in older adults. [ncbi.nlm.nih.gov]

  Periodontal diseases play an evident role in the etiology of aspiration pneumonia due to their effect to alter the oral bacterial flora. [hungary.pure.elsevier.com]

  Abstract The primary problems that predispose to aspiration pneumonia include a reduced level of consciousness, dysphagia, periodontal disease, and mechanical interference that is related to the insertion of various tubes into the respiratory or gastrointestinal [academic.oup.com]

  […] alcoholism, or anesthesia; or dysphagia Absence of rigors Failure to recover likely pulmonary pathogens with cultures of expectorated sputum Sputum that often has a putrid odor, which is considered diagnostic of anaerobic infection Concurrent evidence of periodontal [tistorysjloveu2.tistory.com]

  Periodontal disease is also a major risk factor for development of anaerobic pleuropulmonary infections, as bacterial counts in gingival crevices are markedly elevated in patients with a variety of periodontal diseases. [pulmonologyadvisor.com]

• Dental Caries

  The NHANES III data demonstrate that dental caries and periodontal diseases occur with substantial frequency and represent a burden of unmet treatment need in older adults. [ncbi.nlm.nih.gov]

• Tachycardia

  Both aspiration pneumonia and pneumonitis can present with the following: Fever or hypothermia Tachypnea Tachycardia Decreased breath sounds Dullness to percussion over areas of consolidation Rales Egophony and pectoriloquy Decreased breath sounds Pleural [web.archive.org]

  tachypnea, dyspnea, tachycardia). Mucus production is also increased, which can obstruct airflow and further decrease gas exchange. [quizlet.com]

  Signs may include tachycardia, tachypnoea, decreased breath sounds and dullness to percussion over areas of consolidation, pleural friction rub. Severe infection may lead to hypoxia and septic shock. [patient.info]

  Symptoms and Signs Symptoms and signs include Cough Fever Dyspnea Chest discomfort Chemical pneumonitis caused by gastric contents causes acute dyspnea with cough that is sometimes productive of pink frothy sputum, tachypnea, tachycardia, fever, diffuse [merckmanuals.com]

  Productive cough Shortness of breath Fever (sometimes) Chest pain Patients with aspiration pneumonia may also exhibit with the following signs : Rapid breathing (tachypnea) Rapid heart rate (tachycardia) Abnormal breathing sounds (rales, wheezing, whispering [healthhype.com]

• Cyanosis

  In the absence of an obvious predisposition, the abrupt onset of a self-limited illness characterized by dyspnea, cyanosis, and low-grade fever associated with diffuse rales, hypoxemia, and alveolar infiltrates in dependent lobes should suggest aspiration [ncbi.nlm.nih.gov]

  Pink-colored to red sputum (hemoptysis) Bluish tinge of the lips, fingers and/or toes (cyanosis) Causes Aspiration pneumonia is unlikely to arise in a healthy person who is conscious and has properly functioning gag and cough reflexes. [healthhype.com]

  […] aspiration pneumonia include: chest pain shortness of breath (dyspnea) wheezing fever cough, sometimes with yellow or greenish sputum (mixture of saliva and mucus) fatigue difficulty swallowing (dysphagia) profuse sweating bad breath a bluish skin color (cyanosis [verywellhealth.com]

  Chemical pneumonia The physical symptoms of this type of pneumonia range from tachypnea, tachycardia, wheezing or cyanosis. [symptoma.com]

  Witnessed aspiration was followed by respiratory distress and cyanosis within two hours. The women's X-rays showed infiltrates in one or both lower lobes. [nps.org.au]

• Arthralgia

  […] stabbing chest pains Rapid, shallow, often-painful breathing Less-common symptoms [ edit ] Coughing up blood ( hemoptysis ) Headaches, including migraines Loss of appetite Excessive fatigue Bluish skin ( cyanosis ) Nausea Vomiting Diarrhea Joint pain ( arthralgia [en.wikipedia.org]

• Proximal Muscle Weakness

  Subsequent clinical assessment and investigations revealed the characteristic facies, proximal muscle weakness, lenticular opacities, pulmonary function defects, arterial desaturation and abnormal breathing during rapid eye movement (REM) sleep often [ncbi.nlm.nih.gov]

• Mandibular Prognathism

  The authors present here a patient of aspiration pneumonia after mandibular osteotomy.An 18-year-old female patient underwent sagittal split ramus osteotomy and genioplasty for mandibular prognathism. [ncbi.nlm.nih.gov]

• Psychomotor Retardation

  We present the case of a 4-month-old infant from the Foster Care Center, with severe psychomotor retardation, blindness, and associated cardiac malformation, who was admitted to the Pediatrics Clinic of the Emergency County Hospital of Craiova, Romania [ncbi.nlm.nih.gov]

• Confusion

  They were more likely cared for in the intensive care unit (19% vs 13%, P   0.002), had longer unadjusted hospital length of stay (9 vs 7 days, P CONCLUSIONS: Among pneumonia patients, confusion, nursing home residence, and cerebrovascular disease are [ncbi.nlm.nih.gov]

  You are confused or cannot think clearly. You have more trouble breathing, or your breathing seems faster than normal. When should I contact my healthcare provider? You have a fever. Your symptoms are not better after 2 or 3 days of treatment. [drugs.com]

  Signs and Symptoms of Aspiration Pneumonia There are several signs and symptoms associated with aspiration pneumonia, yet not all victims will show signs of every symptom: Confusion and disorientation Fever Wheezing and/or noisy breathing Shortness of [medmalfirm.com]

• Altered Mental Status

  Additionally, altered mental status on emergency department arrival, white blood cell count, and increased exposure duration were independently associated with the development of aspiration pneumonia. Copyright 2017 Elsevier Inc. All rights reserved. [ncbi.nlm.nih.gov]

  It commonly occurs in patients with altered mental status who have an impaired gag or swallowing reflex. Treatment is directed to the infectious agent or underlying cause. [patientslikeme.com]

  It commonly occurs in patients with altered mental status who have an impaired gag or swallowing reflex. The bacteriology and presentation of aspiration pneumonia have changed over the past five decades. [bestpractice.bmj.com]

• Headache

  Aspiration pneumonia symptoms When it starts it'll probably feel like the worst case of flu you've ever had, with a high temperature, headache and aches and pains. [patient.info]

  […] aspiration pneumonia is similar to that of community-acquired pneumonia and may include the following: Cough Fever or chills Malaise, myalgias Shortness of breath, dyspnea on exertion Pleuritic chest pain Putrid expectoration Nonspecific symptoms including headache [web.archive.org]

  […] therapies for older adults -- Considering complementary & alternative medicines for older adults -- Managing misuse of alcohol & psychoactive prescription medications in older adults -- Assessing older adults for syncope following a fall -- Treating headaches [worldcat.org]

• Agitation

  Increased impulsiveness or agitation 7. Use of medications such as psychotropic, neuroleptic, antidepressants, anticholinergic, or phenothiazine drugs 8. Hyperextended neck or contractures 9. [patientsafetyinstitute.ca]

  Pacemakers, Defibrillators, and Cardiac Resynchronization Devices in Hospital Medicine -- Section 2: Critical Care -- Chapter 137: Inpatient Cardiac Arrest and Cardiopulmonary Resuscitation -- Chapter 138: Acute Respiratory Failure -- Chapter 139: Pain, Agitation [worldcat.org]

  After 2 h, the solution was allowed to be cooled for 4 h with continuous agitation. Then the extract was removed from the apparatus, followed by paper filtration. [ncbi.nlm.nih.gov]

• Stupor

  Confusion/stupor may be only finding -Hypothermia Non-specific findings: diaphoresis, anorexia, fatigue, myalgias, HA, and abd pain -H&P examination -CXR -Gram stain of sputum -Sputum C&S -Pulse ox and/or ABGs -CBC (WBCs), WBC diff -Blood cultures -Sputum [quizlet.com]

From the data obtained from the radiographic evidence of an infiltrate, the diagnosis of aspiration pneumonia can be ascertained. The exact location of the infiltrate is determined by the chest radiograph. Laboratory studies are guided by the symptoms and clinical presentation of the patients.

• CBC with Differential: This test reveals the levels of white blood cells (WBCs). In bacterial and chemical pneumonia, there is an increase in the levels of neutrophils, and thrombocytosis. 
• Chest Radiography: This test helps to ascertain the exact location of the aspiration pneumonia. 
• CT Scanning: Though this test is not needed in all the types of aspiration pneumonia, the technique can help to characterize pleural effusions. It helps to differentiate between the pulmonary and pleural abnormalities.
• Ultrasonography also helps to locate the exact position of the pleura effusions.
• Bronchoscopy: This procedure is indicated in patients with chemical pneumonia when the foreign material is suspected.

• Atelectasis

  Aspiration of particulate matter causes airways obstruction and atelectasis. Most commonly there is a shifting mixed infiltrate in the lower lobes. [ncbi.nlm.nih.gov]

  Contrast-enhanced CT images show tooth aspirated to right main bronchus and associated atelectasis of right mid and lower lobes. [ajronline.org]

  A foreign body in the tracheobronchial tree and associated atelectasis or consolidation can be defined with relative ease on CT scans. [emedicine.medscape.com]

  […] antipyretics, fever, analgesics (chest pain), antiemtic (gerd,proton pump inhibitor) -Pleurisy (Inflammation of the tissues that line the lungs and chest cavity) -Pleural effusion (A buildup of fluid between the tissues that line the lungs and the chest) -Atelectasis [quizlet.com]

  Gastric acid causes a chemical burn of the airways and lungs, leading to rapid bronchoconstriction, atelectasis, edema, and alveolar hemorrhage. [merckmanuals.com]

• Pulmonary Infiltrate

  Aspiration pneumonia is defined as pulmonary infiltration caused by inhaled material, either solid or liquid, that is inherently toxic or that initiates a toxic response. [ncbi.nlm.nih.gov]

  In the past, the use of antibiotics shortly after aspiration in patients who develop a fever, leukocytosis, or a pulmonary infiltrate was discouraged.5 Empiric antibiotics were recommended only for patients who aspirate gastric contents and who have conditions [journalofhospitalmedicine.com]

  Aspiration pneumonia should be suspected in those patients with pulmonary infiltrates and a predisposing cause of aspiration (e.g., dysphagia or fall in consciousness Anaerobes should be suspected in the presence of periodontitis, putrid discharge, infection [link.springer.com]

• Pleural Rub

  A doctor listening to your chest with a stethoscope might hear that your breathing sounds muffled and that the covering of your lungs makes a sound when you breathe in and out (a pleural rub). [patient.info]

Antibiotics: In aspiration pneumonia, antibiotics form the first line in the management procedure. The important points to consider while administering antibiotics in patients with aspiration pneumonia are as follows:

• If the pneumonitis fails to resolve within 48 hours, antibiotics must be administered.
• Patients with small-bowel obstruction must receive antibiotics.
• Patients who are on antacids must be considered for antibiotic therapy since there is an increase in the chances of gastric colonization.
• The choice of antibiotics range ceftriaxone plus azithromycin, levofloxacin, or moxifloxacin, Piperacillin/tazobactam and imipenem or cilastatin along with vancomycin.
• Other antibiotics that can be used to manage the condition include a third-generation cephalosporin with a macrolide or a fluoroquinolone alone [8].

Managing Chemical Aspiration Pneumonia: Important step for the management of chemical pneumonia is maintaining the airways of the secretions by tracheal suctioning and oxygen supplementation. The routine use of corticosteroid must be avoided.

Prognosis of the bacterial and chemical pneumonia depends on the underlying diseases or complications as well as host status. If the bacterial pneumonia is not treated, it can lead to severe complications such as lung abscess and bronchopleural fistula. Longer period of hospitalization is associated with nosocomial pneumonia [6].

Complications

The common complications of aspiration pneumonia are lung abscess, shock, bacteremia, and respiratory failure.

Three different types of materials cause three different types of aspiration pneumonia. They are as follows:

• Chemical pneumonia: Aspiration of the gastric acid cause chemical pneumonia (infectious form) or pneumonitis (or chemical injury).
• Bacterial pneumonia: When the aspiration of bacteria from oral areas causes pneumonia, it is called bacterial pneumonia. Sometimes there is aspiration of some foreign bodies which may predispose patients with this type of pneumonia.
• Exogenous lipoid pneumonia: Aspiration of the oil causes this rare form of pneumonia.

Though aspiration pneumonia includes chemical and bacterial pneumonia, their presentation, pathophysiology and treatment vary [2].

The authentic data for chemical pneumonia is not known, some studies, however, suggest that around 5 to 15% of all the community acquired pneumonia (CAP) results from aspiration pneumonia. The 30-day mortality rate of the aspiration pneumonia was found to be around 21%.

It has been estimated that 1 in every 10 patient hospitalized post drug-overdose were found to have aspiration pneumonitis.

Nosocomial bacterial pneumonia is more common among males than females. Adults were found to be more frequently affected by this disease than the children. The predisposing factors are common among the elderly, making them susceptible to this disease [3].

In patients who develop aspiration pneumonia, the infiltrate increases the risk of oropharyngeal aspiration. The risk is greatly increased in patients with the lower level of consciousness. The three most important determinants of the severity and extent of aspiration pneumonia are nature, and volume of the material aspirated, along with the host defenses.

Chemical pneumonia: This aspiration leads to acute respiratory distress within one hour. The chances of development of this type of pneumonia depend on the levels of consciousness. Since the gastric fluid is acidic in nature, it results in chemical burns. Studies have revealed that if the pH of the aspirated fluid is less than 2.5 and volume aspirated is greater than 0.3 mL/kg of body weight, the chances of chemical pneumonia increase several fold.

Bacterial pneumonia: In persons with impaired airway defense, there is an increased risk of bacterial pneumonia as the inherent mechanism of removing the bacteria is compromised. This type of pneumonia occurs both in community and hospital acquired pneumonia. Anaerobic and micro-aerophilic organisms are believed to play significant role in this disease

Causative microorganisms: The common causative micro-organisms of community acquired aspiration pneumonia are: Streptococcus species (pneumoniae, aureus), Haemophilus influenzae, and Enterobacteriaceae. However, the hospital acquired pneumonia (especially intubated patients) is caused by gram-negative organisms such as Pseudomonas aeruginosa [4] [5].

• Patients with swallowing dysfunction must opt for soft diet.
• Lower risk is associated with patients who use the gastrostomy tubes along with mosapride citrate.
• Patients with altered consciousness who are at the risk of aspiration pneumonia must be positioned in a semi-recumbent position [9] [10].

When the gastric contents or oropharyngeal contents seek passage to the lower airways, it is defined as aspiration.

The passage of the foreign materials to the lungs may cause several syndromes depending on the nature, frequency, host factors and quantity of the material aspirated. Pneumonia that accompanies aspiration is called aspiration pneumonia [1].

Aspiration pneumonia is a serious disease and there are certain conditions that can worsen or increase the chances of complications such as alcoholism, drug overdose, stroke and seizures, trauma to head, dysphagia, esophageal neoplasm, gastroesophageal reflux disease, myasthenia gravis, Parkinson disease and dementia.

Critical illness and use of mechanical devices also contribute to the disease. Hence, awareness of the condition in such patients is advisable.

1. Marik PE. Aspiration pneumonitis and aspiration pneumonia. N Engl J Med. Mar 1 2001;344(9):665-71.
2. Varkey B, Kutty K. Pulmonary aspiration syndromes. In: Kochar's Concise Textbook of Medicine.Baltimore, Md:. Lippincott Williams & Wilkins;1998:902-906.
3. Lanspa MJ, Jones BE, Brown SM, Dean NC. Mortality, morbidity, and disease severity of patients with aspiration pneumonia. J Hosp Med. Feb 2013;8(2):83-90. 
4. Marik PE, Careau P. The role of anaerobes in patients with ventilator-associated pneumonia and aspiration pneumonia: a prospective study. Chest. Jan 1999;115(1):178-83. 
5. Mier L, Dreyfuss D, Darchy B, Lanore JJ, Djedaïni K, Weber P, et al. Is penicillin G an adequate initial treatment for aspiration pneumonia? A prospective evaluation using a protected specimen brush and quantitative cultures. Intensive Care Med. 1993;19(5):279-84. 
6. Lanspa MJ, Jones BE, Brown SM, Dean NC. Mortality, morbidity, and disease severity of patients with aspiration pneumonia. J Hosp Med. Feb 2013;8(2):83-90.
7. Akritidis N, Gousis C, Dimos G, Paparounas K. Fever, cough, and bilateral lung infiltrates. Achalasia associated with aspiration pneumonia. Chest. Feb 2003;123(2):608-12.
8. Moore FA. Treatment of aspiration in intensive care unit patients. JPEN J Parenter Enteral Nutr. Nov-Dec 2002;26(6 Suppl):S69-74; discussion S74.
9. Vadeboncoeur TF, Davis DP, Ochs M, Poste JC, Hoyt DB, Vilke GM. The ability of paramedics to predict aspiration in patients undergoing prehospital rapid sequence intubation. J Emerg Med. Feb 2006;30(2):131-6. 
10. Loeb MB, Becker M, Eady A, Walker-Dilks C. Interventions to prevent aspiration pneumonia in older adults: a systematic review. J Am Geriatr Soc. Jul 2003;51(7):1018-22.