Pekacka-Egli Anna Maria, Herrmann Jana, Spielmanns Marc, Goerg Arthur, Schulz Katharina, Zenker Eveline, Windisch Wolfram, Kulnik Stefan Tino
Department for Pulmonary Medicine and Sleep Medicine, Zürcher RehaZentren, Klinik Wald, 8636 Wald, Switzerland.
Department for Neurology and Neurorehabilitation, Zürcher RehaZentren, Klinik Wald, 8636 Wald, Switzerland.
Geriatrics (Basel). 2022 Feb 28;7(2):27. doi: 10.3390/geriatrics7020027.
Dysphagia and aspiration risk are common sequelae of stroke, leading to increased risk of stroke-associated pneumonia. This is often aggravated by stroke-related impairment of cough, the most immediate mechanical defense mechanism against aspiration. In humans, reflex cough can be repeatedly and safely elicited by inhalation of nebulized capsaicin, a compound contained in chili peppers. Could this cough-eliciting property of capsaicin support the recovery of stroke survivors who present with dysphagia and aspiration risk? We present a clinical case report of a 73-year-old man, admitted to inpatient stroke rehabilitation following a right middle cerebral artery infarct with subsequent dysphagia and hospital-acquired pneumonia. A course of daily inhalation therapy with nebulized capsaicin was initiated, triggering reflex coughs to support secretion clearance and prevent recurrence of pneumonia. Clinical observations in each inhalation therapy session demonstrate good patient response, safety and tolerability of nebulized capsaicin in this mode of application. Repeated Fiberoptic Endoscopic Evaluation of Swallowing (FEES) assessments show concurrent improvement in the patient's swallowing status. Inhalation therapy with nebulized capsaicin may offer a viable treatment to facilitate coughing and clearing of secretions, and to minimize aspiration and risk of aspiration-related pneumonia post stroke. Further investigation in a randomized controlled trial design is warranted.
吞咽困难和误吸风险是中风常见的后遗症，会增加中风相关性肺炎的风险。中风导致的咳嗽功能障碍往往会加重这种情况，而咳嗽是防止误吸的最直接机械防御机制。在人类中，雾化吸入辣椒素（一种辣椒中含有的化合物）可反复且安全地引发反射性咳嗽。辣椒素的这种引发咳嗽的特性能否帮助患有吞咽困难和误吸风险的中风幸存者康复？我们报告了一例73岁男性的临床病例，该患者因右侧大脑中动脉梗死伴随后续吞咽困难和医院获得性肺炎入住中风康复病房。开始了为期一个疗程的雾化辣椒素每日吸入治疗，引发反射性咳嗽以促进分泌物清除并预防肺炎复发。每次吸入治疗期间的临床观察表明，患者对此反应良好，雾化辣椒素在这种应用方式下具有安全性和耐受性。多次纤维内镜吞咽功能评估（FEES）显示患者的吞咽状况同时得到改善。雾化辣椒素吸入治疗可能是一种可行的治疗方法，有助于促进咳嗽和清除分泌物，并最大限度地减少中风后误吸及误吸相关性肺炎的风险。有必要在随机对照试验设计中进行进一步研究。
