Chronic Aspiration

Aspiration is a common problem that can occur in healthy or sick patients wherein pharyngeal secretions, food material, or gastric secretions enter the larynx and trachea and can descend into the lungs, causing an acute or chronic inflammatory reaction. The term chronic aspiration refers to a common condition in the elderly population, pediatric patients with certain neurological disorders, and chronically intubated patients. Aspiration can be further classified into microaspiration and macroaspiration by the subjective amount of aspirate. Microaspiration occurs with minuscule amounts of foreign material are inhaled, while macroaspiration occurs when large amounts of foreign material are inhaled. There is not a specific differentiating cut-off. Chronic aspiration is most often secondary to microaspiration. The consequences of a single episode of aspiration vary from benign to catastrophic depending on the nature and volume of aspirated material. While aspiration can occur in healthy patients, repetitive and, thus, chronic aspiration indicates underlying pathology in the functioning of a healthy individual’s ability to speak, swallow, breathe, or maintain airway protection. Chronic aspiration commonly affects three main demographics with specific comorbidities: children, elderly, and intensive care unit (ICU) patients. It is the cause of significant morbidity and mortality in these populations. In children, chronic pulmonary aspiration is one of the leading causes of death in neurologically impaired patients. Patients with dysphagia have triple the rates of pneumonia and suffer from a 2.9% increase in in-hospital mortality.