Department of Internal Medicine and Rehabilitation Science, Tohoku University Graduate School of Medicine, Seiryo-machi 1-1, Aoba-ku, Sendai 980-8574, Japan.
Pulm Pharmacol Ther. 2011 Jun;24(3):318-23. doi: 10.1016/j.pupt.2010.10.003. Epub 2010 Oct 15.
Management of cough in the elderly with a deteriorated physical and mental status has received little focus. Since an aged population is rapidly increasing in developed countries, the research in this population are warranted. Cough reflex sensitivity in the elderly was shown to be hypersensitive, normosensitive and hyposensitive. The hypersensitive cough reflex is mostly due to gastro-esophageal reflux in nursing home patients. Impaired cough reflex sensitivity is assumed to play a crucial role in the development of pneumonia in the elderly. A marked depression of cough reflex sensitivity is reported in elderly patients with aspiration pneumonia. The impairment of the cough reflex in patients with aspiration pneumonia can involve both cortical facilitatory pathways for cough and medullary reflex pathways. We found the urge-to-cough in patients with aspiration pneumonia was also down-regulated, suggesting the involvement of supramedullary dysfunction in the etiology of aspiration pneumonia in the elderly. In order to prevent aspiration pneumonia in the elderly, restoration of cough reflex sensitivity is essential. We found several methods to restore cough reflex sensitivity in the elderly. They also improved the swallowing reflex, another important airway protective reflex, in the elderly. In the treatment of aspiration pneumonia, one of the most challenging steps is the start of eating for patients who usually fast at the time of hospitalization. By combining the methods to restore the cough reflex sensitivity and swallowing reflex, we developed a protocol to start eating in the elderly patients with aspiration pneumonia. Using the protocol, we reduced the incidence of re-aspiration due to start of eating in patients with aspiration pneumonia to one third of the patients without the protocol.
对于身体和精神状况恶化的老年患者的咳嗽管理关注甚少。由于发达国家的老年人口迅速增加，因此有必要对这一人群进行研究。研究表明，老年人的咳嗽反射敏感性可表现为超敏、正常和低敏。超敏性咳嗽反射主要归因于养老院患者的胃食管反流。人们认为，咳嗽反射敏感性受损在老年人肺炎的发生中起关键作用。有研究报道，在患有吸入性肺炎的老年患者中，咳嗽反射敏感性显著降低。吸入性肺炎患者咳嗽反射的损害可涉及咳嗽的皮质促进途径和延髓反射途径。我们发现，吸入性肺炎患者的咳嗽欲望也受到抑制，这表明在老年人吸入性肺炎的病因中涉及延髓以上的功能障碍。为了预防老年人的吸入性肺炎，恢复咳嗽反射敏感性至关重要。我们发现了几种恢复老年人咳嗽反射敏感性的方法。这些方法还改善了老年人的吞咽反射，这是另一种重要的气道保护反射。在治疗吸入性肺炎时，最具挑战性的步骤之一是让通常在住院期间禁食的患者开始进食。通过结合恢复咳嗽反射敏感性和吞咽反射的方法，我们为吸入性肺炎的老年患者制定了开始进食的方案。使用该方案，我们将吸入性肺炎患者因开始进食而再次吸入的发生率降低到没有该方案的患者的三分之一。
