Dy Fei Jamie, Midyat Levent, Wong Wai Y, Haver Kenan
Division of Pulmonary Medicine, University of Massachusetts, Memorial Medical Center, Worcester, Massachusetts, USA.
Division of Pulmonary Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.
Pediatr Allergy Immunol Pulmonol. 2020 Sep;33(3):142-146. doi: 10.1089/ped.2020.1201.
Pulmonary aspiration in infants and children is common, with 25% of the pediatric population reported to experience some type of nonspecific swallowing dysfunction. Diagnosing and managing oropharyngeal aspiration remain a challenging task due to the lack of distinguishing clinical or laboratory characteristics. We conducted a large, physician-based survey in an effort to determine the differences in the diagnosis and management of patients with oropharyngeal aspiration across different centers, using a quantitative online questionnaire. A survey was developed with the goal of understanding the physician demographics, diagnosis, management strategies, and the role of specialized centers for airway, voice, and swallowing disorders (also known as Aerodigestive Disease Centers). The questionnaire was sent to the pediatric membership of the American Thoracic Society. A total of 136 questionnaires were completed and physicians from 42 different Aerodigestive Digestive Centers participated in the survey. Ninety-two percent of respondents believed that the evidence is unclear on the best methods for diagnosing lung disease related to oropharyngeal aspiration. Modified barium swallow (MBS) study and fiberoptic endoscopic evaluation of swallowing were the most useful studies in making the diagnosis of the oropharyngeal aspiration according to the participants. The majority of the participants preferred to repeat the feeding evaluations and MBS after the initial intervention. For children with suspected or confirmed aspiration, 68.6% of the respondents stated that they combine endoscopy and flexible and/or rigid bronchoscopy for further evaluation, while 27.1% preferred to perform the procedures individually at the discretion of each specialty provider. Inhaled corticosteroids were mostly prescribed if there was any component of bronchial hyperreactivity, and acid suppression therapy was primarily prescribed if there was a diagnosis or suspicion of gastroesophageal reflux disease. Empirical thickening of the feeds was not uniformly performed among the aerodigestive centers as a therapy method for the children with swallowing dysfunction with aspiration. In the survey, physicians mentioned about the importance of better guidelines for aspiration, the requirement of new diagnostic measures, the necessity of multicenter trials of sensitivity and specificity of current diagnostic tools, and developing a scoring system for reading the radiological studies for children with oropharyngeal aspiration.
婴幼儿的肺误吸很常见，据报道，25%的儿科患者存在某种类型的非特异性吞咽功能障碍。由于缺乏可区分的临床或实验室特征，诊断和管理口咽误吸仍然是一项具有挑战性的任务。我们开展了一项基于医生的大型调查，旨在通过定量在线问卷确定不同中心对口咽误吸患者的诊断和管理差异。设计该调查的目的是了解医生的人口统计学特征、诊断、管理策略，以及气道、嗓音和吞咽障碍专科中心（也称为气消化道疾病中心）的作用。问卷发送给了美国胸科学会的儿科会员。共完成了136份问卷，来自42个不同气消化道疾病中心的医生参与了调查。92%的受访者认为，关于诊断与口咽误吸相关肺部疾病的最佳方法，证据尚不明确。根据参与者的说法，改良钡餐吞咽（MBS）研究和纤维内镜吞咽评估是诊断口咽误吸最有用的检查。大多数参与者倾向于在初始干预后重复进行喂养评估和MBS。对于疑似或确诊误吸的儿童，68.6%的受访者表示，他们会结合内镜检查和柔性及/或刚性支气管镜检查进行进一步评估，而27.1%的受访者则倾向于由各专科医生酌情单独进行这些检查。如果存在任何支气管高反应性成分，大多会开具吸入性糖皮质激素；如果诊断或怀疑患有胃食管反流病，则主要开具抑酸治疗药物。作为吞咽功能障碍伴误吸儿童的一种治疗方法，气消化道疾病中心并未统一采用经验性增稠喂养。在调查中，医生们提到了制定更好的误吸指南的重要性、新诊断措施的需求、对当前诊断工具的敏感性和特异性进行多中心试验的必要性，以及为口咽误吸儿童的放射学检查制定评分系统。
