The inflammation caused by this reaction can rapidly cause similar findings seen in aspiration pneumonia, such as an elevated WBC (white blood cell) count, radiologic findings, and fever. However, it is important to note that the findings of chemical pneumonitis are triggered by inflammation not caused by infection, as seen in aspiration pneumonia. Inflammation is the bodys immune response to any perceived threat to the body. Thus, treatment of chemical pneumonitis typically involves removal of the inflammatory fluid and supportive measures, notably excluding antibiotics. The use of antimicrobials is reserved for chemical pneumonitis complicated by secondary bacterial infection. Prevention
There have been several practices associated with decreased incidence and decreased severity of aspiration pneumonia as detailed below. Oral hygiene
Studies showed that the net reduction of oral bacteria was associated with a decrease in both incidence of aspiration pneumonia as well as mortality from aspiration pneumonia. One broad method of decreasing the number of bacteria in the mouth involves the use of antimicrobials, ranging from topical antibiotics to intravenous antibiotic use. Whereas the use of antibiotics focuses on destroying and hindering the growth of bacteria, mechanical removal of oral bacteria by a dental professional also plays a key role in reducing the bacterial burden. By reducing the amount of bacteria in the mouth, the likelihood of infection when aspiration occurs is reduced as well.
Elderly
Aging increases the risk of dysphagia. The prevalence of dysphagia in nursing homes is approximately 50%, and 30% of the elderly with dysphagia develop aspiration. For individuals older than 75, the risk of pneumonia due to dysphagia, is six times greater than those 65. Owing to multiple factors, such as frailty, impaired efficacy of swallowing, decreased cough reflex and neurological complications, dysphagia can be considered as a geriatric syndrome. Atypical presentation is common in the elderly. Older patients may have impaired T cell function and hence, they may be unable to mount a febrile response. The mucociliary clearance of older people is also impaired, resulting in diminished sputum production and cough. Therefore, they can present non-specifically with different geriatric syndromes. Microaspirations
In the elderly, dysphagia is a significant risk factor for the development of aspiration pneumonia. Aspiration pneumonia most often develops due to micro-aspiration of saliva, or bacteria carried on food and liquids, in combination with impaired host immune function. Chronic inflammation of the lungs is a key feature in aspiration pneumonia in elderly nursing home residents and presents as a sporadic fever (one day per week for several months). Radiological review shows chronic inflammation in the consolidated lung tissue, linking chronic micro-aspiration and chronic lung inflammation. Choking
After falls, choking on food presents as the second highest cause of preventable death in aged care. Although food choking risk is commonly associated with young children, data shows that individuals over 65 years of age have a choking incidence that is seven times higher than children aged 1–4 years.