These studies allow for evaluation of penetration to the vocal folds and below but are not a sensitive and specific marker for aspiration. Additionally, it is difficult to distinguish between aspiration pneumonia and aspiration pneumonitis.Aspiration pneumonia is typically diagnosed by a combination of clinical circumstances (people with risk factors for aspiration) and radiologic findings (an infiltrate in the proper location). A chest x-ray is typically performed in cases where any pneumonia is suspected, including aspiration pneumonia. Findings on chest x-ray supportive of aspiration pneumonia include localized consolidation depending on the patients position when the aspiration occurred. For example, people that are supine when they aspirate often develop consolidation in the right lower lobe of the lung. Sputum cultures are not used for diagnosing aspiration pneumonia because of the high risk of contamination. Clinical symptoms may also increase suspicion of aspiration pneumonia, including new difficulty breathing and fever after an aspiration event. Likewise, physical exam findings such as altered breath sounds heard in the affected lung fields may also be suggestive of aspiration pneumonia. Some cases of aspiration pneumonia are caused by aspiration of food particles or other particulate substances like pill fragments; these can be diagnosed by pathologists on lung biopsy specimens.While aspiration pneumonia and chemical pneumonitis may appear similar, it is important to differentiate between the two due to major differences in management of these conditions. Chemical pneumonitis is caused by damage to the inner layer of lung tissue, which triggers an influx of fluid.
If there is a large accumulation of fluid within the lungs, drainage of the fluid may also aid in the healing process. Prognosis
Dysphagia clinicians often recommend alteration of dietary regimens, altered head positioning, or removal of all oral intake. While studies have suggested that thickening liquids can decrease aspiration through slowed pharyngeal transit time, they have also demonstrated increased pharyngeal residues with risk for delayed aspiration. The ability of clinical interventions to reduce pneumonia incidence is relatively unknown. Dietary modifications or nothing-by-mouth status also have no effect on a patients ability to handle their own secretions. A patients individual vigor may impact the development of pulmonary infections more than aspiration. Also increased pneumonia risk exists in patients with esophageal dysphagia when compared to stroke patients because patients with stroke will improve as they recover from their acute injury, whereas esophageal dysphagia is likely to worsen with time. In one cohort of aspiration pneumonia patients, overall three-year mortality was 40%.Studies have shown that aspiration pneumonia has been associated with an overall increased in-hospital mortality as compared with other forms of pneumonia. Further studies investigating differing time spans including 30-day mortality, 90-day mortality, and 1-year mortality. Individuals diagnosed with aspiration pneumonia were also at increased risk of developing future episodes of pneumonia. In fact, these individuals were also found to be at higher risk for readmission after being discharged from the hospital. Lastly, one study found that individuals diagnosed with aspiration pneumonia were more likely to fail treatment compared to other types of pneumonia.