Skip to main content
SpringerLink
Log in

The Relationship Between the Risk of Aspiration Pneumonia and the Risk of Aspiration: Aspiration Risk and Aspiration Pneumonia Risk Are Not the Same?

  • Chapter
  • First Online:
Aspiration Pneumonia

Abstract

Reported risks for aspiration include cerebrovascular disease, laryngopharyngeal dysfunction, advanced age, severe dementia, Parkinson’s disease, malnutrition, the use of antipsychotic drugs, and gastroesophageal reflux. Although the aspiration risks may be included among the risks for aspiration pneumonia, the two sets of risks are not identical, and people with aspiration risk factors do not necessarily develop aspiration pneumonia. The risks for aspiration pneumonia also include factors related to the pathogens and to the host defense. Factors associated with the risk of pathogen infection include oral health, such as bacterial colonization and tooth decay, and the use of proton pump inhibitors, and host defense factors associated with the pathogenesis include advanced age, male gender, a preexisting respiratory disease, angiotensin-converting enzyme genotype, malnutrition, diabetes mellitus, and the use of immunosuppressants. Consideration of the relationships between the pathogen, host, and environment is needed for a better understanding of the mechanisms that underlie aspiration pneumonia and for developing effective strategies for its prevention.

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. Society TJR. The JRS guidelines for the management of pneumonia in adults. 2017. [in Japanese].

    Google Scholar 

  2. Komiya K, Ishii H, Kadota J. Healthcare-associated pneumonia and aspiration pneumonia. Aging Dis. 2015;6(1):27–37.

    Article  PubMed  Google Scholar 

  3. Marik PE, Kaplan D. Aspiration pneumonia and dysphagia in the elderly. Chest. 2003;124(1):328–36.

    Article  PubMed  Google Scholar 

  4. Sumi Y, Miura H, Michiwaki Y, Nagaosa S, Nagaya M. Colonization of dental plaque by respiratory pathogens in dependent elderly. Arch Gerontol Geriatr. 2007;44(2):119–24.

    Article  PubMed  Google Scholar 

  5. Scholthof KB. The disease triangle: pathogens, the environment and society. Nat Rev Microbiol. 2007;5(2):152–6.

    Article  CAS  PubMed  Google Scholar 

  6. Parrilla C, Valenza V, Calo L, Passali GC, Castaldi P, Galli J. Is it sufficient to quantify aspiration for predicting aspiration pneumonia? Clin Nucl Med. 2008;33(3):236–9.

    Article  PubMed  Google Scholar 

  7. van der Maarel-Wierink CD, Vanobbergen JN, Bronkhorst EM, Schols JM, de Baat C. Risk factors for aspiration pneumonia in frail older people: a systematic literature review. J Am Med Dir Assoc. 2011;12(5):344–54.

    Article  PubMed  Google Scholar 

  8. Mandell LA, Niederman MS. Aspiration pneumonia. N Engl J Med. 2019;380(7):651–63.

    Article  CAS  PubMed  Google Scholar 

  9. Sura L, Madhavan A, Carnaby G, Crary MA. Dysphagia in the elderly: management and nutritional considerations. Clin Interv Aging. 2012;7:287–98.

    PubMed  PubMed Central  Google Scholar 

  10. Cohen DL, Roffe C, Beavan J, Blackett B, Fairfield CA, Hamdy S, et al. Post-stroke dysphagia: a review and design considerations for future trials. Int J Stroke. 2016;11(4):399–411.

    Article  PubMed  Google Scholar 

  11. Hannawi Y, Hannawi B, Rao CP, Suarez JI, Bershad EM. Stroke-associated pneumonia: major advances and obstacles. Cerebrovasc Dis. 2013;35(5):430–43.

    Article  CAS  PubMed  Google Scholar 

  12. Barbon CE, Steele CM. Efficacy of thickened liquids for eliminating aspiration in head and neck cancer: a systematic review. Otolaryngol Head Neck Surg. 2015;152(2):211–8.

    Article  PubMed  Google Scholar 

  13. Nakagawa T, Sekizawa K, Nakajoh K, Tanji H, Arai H, Sasaki H. Silent cerebral infarction: a potential risk for pneumonia in the elderly. J Intern Med. 2000;247(2):255–9.

    Article  CAS  PubMed  Google Scholar 

  14. Xu Z, Gu Y, Li J, Wang C, Wang R, Huang Y, et al. Dysphagia and aspiration pneumonia in elderly hospitalization stroke patients: risk factors, cerebral infarction area comparison. J Back Musculoskelet Rehabil. 2019;32(1):85–91.

    Article  PubMed  Google Scholar 

  15. Takizawa C, Gemmell E, Kenworthy J, Speyer R. A systematic review of the prevalence of oropharyngeal dysphagia in stroke, Parkinson’s disease, Alzheimer’s disease, head injury, and pneumonia. Dysphagia. 2016;31(3):434–41.

    Article  PubMed  Google Scholar 

  16. Meyer KC. Gastroesophageal reflux and lung disease. Expert Rev Respir Med. 2015;9(4):383–5.

    Article  CAS  PubMed  Google Scholar 

  17. Bar-Sever Z. Scintigraphic evaluation of gastroesophageal reflux and pulmonary aspiration in children. Semin Nucl Med. 2017;47(3):275–85.

    Article  PubMed  Google Scholar 

  18. Teramoto S, Yamamoto H, Yamaguchi Y, Tmoita T, Ouchi Y. Diffuse aspiration bronchiolitis due to achalasia. Chest. 2004;125(1):349–50.

    Article  PubMed  Google Scholar 

  19. Manabe T, Teramoto S, Tamiya N, Okochi J, Hizawa N. Risk factors for aspiration pneumonia in older adults. PLoS One. 2015;10(10):e0140060.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  20. Stevenson RD, Allaire JH. The development of normal feeding and swallowing. Pediatr Clin N Am. 1991;38(6):1439–53.

    Article  CAS  Google Scholar 

  21. Steele CM, Cichero JA. Physiological factors related to aspiration risk: a systematic review. Dysphagia. 2014;29(3):295–304.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Sjogren P, Wardh I, Zimmerman M, Almstahl A, Wikstrom M. Oral care and mortality in older adults with pneumonia in hospitals or nursing homes: systematic review and meta-analysis. J Am Geriatr Soc. 2016;64(10):2109–15.

    Article  PubMed  Google Scholar 

  23. Yoneyama T, Yoshida M, Ohrui T, Mukaiyama H, Okamoto H, Hoshiba K, et al. Oral care reduces pneumonia in older patients in nursing homes. J Am Geriatr Soc. 2002;50(3):430–3.

    Article  PubMed  Google Scholar 

  24. Terpenning MS, Taylor GW, Lopatin DE, Kerr CK, Dominguez BL, Loesche WJ. Aspiration pneumonia: dental and oral risk factors in an older veteran population. J Am Geriatr Soc. 2001;49(5):557–63.

    Article  CAS  PubMed  Google Scholar 

  25. Scannapieco FA, Cantos A. Oral inflammation and infection, and chronic medical diseases: implications for the elderly. Periodontology. 2000;72(1):153–75.

    Article  Google Scholar 

  26. Awano S, Ansai T, Takata Y, Soh I, Akifusa S, Hamasaki T, et al. Oral health and mortality risk from pneumonia in the elderly. J Dent Res. 2008;87(4):334–9.

    Article  CAS  PubMed  Google Scholar 

  27. Almirall J, Bolibar I, Serra-Prat M, Roig J, Hospital I, Carandell E, et al. New evidence of risk factors for community-acquired pneumonia: a population-based study. Eur Respir J. 2008;31(6):1274–84.

    Article  CAS  PubMed  Google Scholar 

  28. Tanner AC. Anaerobic culture to detect periodontal and caries pathogens. J Oral Biosci. 2015;57(1):18–26.

    Article  PubMed  Google Scholar 

  29. Sanz M, Beighton D, Curtis MA, Cury JA, Dige I, Dommisch H, et al. Role of microbial biofilms in the maintenance of oral health and in the development of dental caries and periodontal diseases. Consensus report of group 1 of the Joint EFP/ORCA workshop on the boundaries between caries and periodontal disease. J Clin Periodontol. 2017;44(Suppl 18):S5–S11.

    Article  PubMed  Google Scholar 

  30. Marsh PD. Microbial ecology of dental plaque and its significance in health and disease. Adv Dent Res. 1994;8(2):263–71.

    Article  CAS  PubMed  Google Scholar 

  31. Marik PE, Careau P. The role of anaerobes in patients with ventilator-associated pneumonia and aspiration pneumonia: a prospective study. Chest. 1999;115(1):178–83.

    Article  CAS  PubMed  Google Scholar 

  32. Bowerman TJ, Zhang J, Waite LM. Antibacterial treatment of aspiration pneumonia in older people: a systematic review. Clin Interv Aging. 2018;13:2201–13.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Bartlett JG. How important are anaerobic bacteria in aspiration pneumonia: when should they be treated and what is optimal therapy. Infect Dis Clin N Am. 2013;27(1):149–55.

    Article  Google Scholar 

  34. Zirk-Sadowski J, Masoli JA, Delgado J, Hamilton W, Strain WD, Henley W, et al. Proton-pump inhibitors and long-term risk of community-acquired pneumonia in older adults. J Am Geriatr Soc. 2018;66(7):1332–8.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Lambert AA, Lam JO, Paik JJ, Ugarte-Gil C, Drummond MB, Crowell TA. Risk of community-acquired pneumonia with outpatient proton-pump inhibitor therapy: a systematic review and meta-analysis. PLoS One. 2015;10(6):e0128004.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  36. Loeb M, Neupane B, Walter SD, Hanning R, Carusone SC, Lewis D, et al. Environmental risk factors for community-acquired pneumonia hospitalization in older adults. J Am Geriatr Soc. 2009;57(6):1036–40.

    Article  PubMed  Google Scholar 

  37. Rafailidis PI, Matthaiou DK, Varbobitis I, Falagas ME. Use of ACE inhibitors and risk of community-acquired pneumonia: a review. Eur J Clin Pharmacol. 2008;64(6):565–73.

    Article  CAS  PubMed  Google Scholar 

  38. Nie W, Zang Y, Chen J, Liu T, Xiao L, Xiu Q. Angiotensin-converting enzyme I/D polymorphism is associated with pneumonia risk: a meta-analysis. JRAAS. 2014;15(4):585–92.

    CAS  PubMed  Google Scholar 

  39. Takahashi T, Morimoto S, Okaishi K, Kanda T, Nakahashi T, Okuro M, et al. Reduction of pneumonia risk by an angiotensin I-converting enzyme inhibitor in elderly Japanese inpatients according to insertion/deletion polymorphism of the angiotensin I-converting enzyme gene. Am J Hypertens. 2005;18(10):1353–9.

    Article  CAS  PubMed  Google Scholar 

  40. Tilley AE, Walters MS, Shaykhiev R, Crystal RG. Cilia dysfunction in lung disease. Annu Rev Physiol. 2015;77:379–406.

    Article  CAS  PubMed  Google Scholar 

  41. Ma J, Rubin BK, Voynow JA. Mucins, mucus, and goblet cells. Chest. 2018;154(1):169–76.

    Article  PubMed  Google Scholar 

  42. Festic E, Bansal V, Gupta E, Scanlon PD. Association of inhaled corticosteroids with incident pneumonia and mortality in COPD patients; systematic review and meta-analysis. COPD. 2016;13(3):312–26.

    Article  PubMed  Google Scholar 

  43. Ernst P, Saad N, Suissa S. Inhaled corticosteroids in COPD: the clinical evidence. Eur Respir J. 2015;45(2):525–37.

    Article  CAS  PubMed  Google Scholar 

  44. Yang M, Du Y, Chen H, Jiang D, Xu Z. Inhaled corticosteroids and risk of pneumonia in patients with chronic obstructive pulmonary disease: a meta-analysis of randomized controlled trials. Int Immunopharmacol. 2019;77:105950.

    Article  PubMed  CAS  Google Scholar 

  45. Leung JM, Tiew PY, Mac Aogain M, Budden KF, Yong VF, Thomas SS, et al. The role of acute and chronic respiratory colonization and infections in the pathogenesis of COPD. Respirology. 2017;22(4):634–50.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Vogelmeier CF, Criner GJ, Martinez FJ, Anzueto A, Barnes PJ, Bourbeau J, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive lung disease 2017 report. GOLD executive summary. Am J Respir Crit Care Med. 2017;195(5):557–82.

    Article  CAS  PubMed  Google Scholar 

  47. Zheng Z, Wu Z, Liu N, Chen P, Hou P, Wang X, et al. Silent aspiration in patients with exacerbation of COPD. Eur Respir J. 2016;48(2):570–3.

    Article  PubMed  Google Scholar 

  48. Gross RD, Atwood CW Jr, Ross SB, Olszewski JW, Eichhorn KA. The coordination of breathing and swallowing in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2009;179(7):559–65.

    Article  PubMed  Google Scholar 

  49. Hou P, Deng H, Wu Z, Liu H, Liu N, Zheng Z, et al. Detection of salivary aspiration using radionuclide salivagram SPECT/CT in patients with COPD exacerbation: a preliminary study. J Thorac Dis. 2016;8(10):2730–7.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Ryerson CJ, Cottin V, Brown KK, Collard HR. Acute exacerbation of idiopathic pulmonary fibrosis: shifting the paradigm. Eur Respir J. 2015;46(2):512–20.

    Article  PubMed  Google Scholar 

  51. Gavini S, Borges LF, Finn RT, Lo WK, Goldberg HJ, Burakoff R, et al. Lung disease severity in idiopathic pulmonary fibrosis is more strongly associated with impedance measures of bolus reflux than pH parameters of acid reflux alone. Neurogastroenterol Motil. 2017;29(5):e13001.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, Oita, Japan

    Kosaku Komiya & Jun-Ichi Kadota

Authors
  1. Kosaku Komiya
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jun-Ichi Kadota
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kosaku Komiya .

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

Komiya, K., Kadota, JI. (2020). The Relationship Between the Risk of Aspiration Pneumonia and the Risk of Aspiration: Aspiration Risk and Aspiration Pneumonia Risk Are Not the Same?. 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_8

Download citation

  • DOI: https://doi.org/10.1007/978-981-15-4506-1_8

  • 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