Evaluation of the natural history of patients who aspirate

Abstract

Objectives/hypothesis The natural clinical progression of aspiration to eventual pulmonary compromise is not well understood. We hypothesized that dietary modification recommendations, penetration-aspiration scale (PAS) score, and dysphagia etiology would be associated with changes in time to first pulmonary event and overall survival for patients with documented aspiration on radiologic testing. This study identified a cohort of patients with detectable unsensed penetration or aspiration on videofluoroscopic swallowing study (VFSS) and followed this cohort over time for development of pulmonary events and death. We then evaluated the association of aspiration severity and dietary modification recommendations on incidence of these endpoints. Study Type/Design Retrospective chart review. Methods A total of 2616 VFSS exam reports were reviewed from our institution performed between January 1, 2009 and December 31, 2010. Aspiration or unsensed penetration (PAS of 5 or greater) was detected in 564 (21.5%) of these patients, who were then included in the study cohort. Medical records were reviewed retrospectively for development of pulmonary events (pneumonia, pneumonitis, or other life-threatening pulmonary illness) and all-cause mortality for up to 54 months after initial VFSS. Univariate Kaplan-Meier analysis and multivariate Cox regression were performed for time to first pulmonary event and survival predicted by recommended diet, PAS score, and dysphagia etiology. Results Dysphagia etiology was highly associated with increased development of pulmonary events for some patients, especially those with generalized nonspecific dysphagia due to deconditioning or frailty (hazard ratio [HR] versus stroke 2.95, 95% CI: 1.53–5.69, p=0.001) and esophageal dysphagia (HR 2.66, 95% CI: 1.17–6.02, p=0.019). Dysphagia etiology was also associated with increased mortality for patients with generalized nonspecific dysphagia due to deconditioning or frailty (HR 3.32, 95% CI: 2.0–5.52, p<0.001), post-surgical patients (HR 1.73, 95% CI: 1.05–2.86, p=0.032) and chronic neurologic disease (HR 1.87, 95% CI: 1.12–3.13, p=0.017). Dietary modification recommendations at the time of VFSS (prohibition of oral intake or modification of food consistency) had no significant impact on time to first pulmonary event (p=0.37) or survival (p=0.17), while PAS score was associated with decreased time to first pulmonary event on univariate but not multivariate analysis (hazard ratio for 1-point increase 1.6, 95% CI: 0.99–1.36, p=0.067). Kaplan-Meier estimate of overall 3-year mortality for this patient cohort was 39%. Conclusions Etiology of dysphagia is associated with a higher mortality rate and development of pulmonary events in patients with unsensed penetration or aspiration on VFSS, especially for those patients with generalized deconditioning and frailty or esophageal dysphagia. Severity of aspiration as defined by PAS was not associated with altered overall survival. Recommendations for dietary modification to an NPO status or modifie...

Aspiration in the otherwise healthy Infant—Is there a natural course for improvement?

“…Knowing when the child's dysphagia will improve and when to intervene is not always clear. A recent publication attempted to characterize the natural history of patients who aspirate . In this retrospective review of approximately 564 patients, dysphagia etiology (neurologic, stroke, trauma, postsurgical head and neck or laryngeal surgery, laryngeal dysfunction, esophageal dysfunction, or dysphagia not otherwise specified) was associated with both increased development of a pulmonary event and an increased mortality.…”

Deliberações clínicas na atuação em pacientes com câncer de cabeça e pescoço: atualidades e desafios na disfagia

“…Portanto, ambos devem ser tratados de maneira semelhante, embora a duração do tratamento das disfagias transitórias possa ser abreviada devido à recuperação natural. Em contraste, os pacientes que apresentam disfagia trutiva crônica), um simples medidor de pico de fluxo respiratório, indicação de tratamentos mais conservadores, terapia intensiva e um aconselhamento mais assertivo sobre os riscos e estratégias terapêuticas podem ser uma adição significativa ao conjunto de ferramentas do clínico da disfagia 1,4,5 .…”

“…progressiva, podem exigir estratégias de tratamento singulares para retardar ou interromper a progressão da fibrose. A DAR de início tardio se enquadra nessa categoria progressiva, embora tipicamente se apresentasse em um momento posterior (> 5 anos após a radiação) 2,[5][6][7][8] .…”

Food bolus‐forming ability predicts incidence of aspiration pneumonia in nursing home older adults: A prospective observational study

“…It is difficult to distinguish aspiration pneumonia from other nursing home acquired pneumonia; however, high proportion of aspiration pneumonia is estimated due to high prevalence of dysphagia among this population. The prevalence of oropharyngeal dysphagia is around 60% in nursing homes, and aspiration of food is recognised as a risk factor for aspiration pneumonia . Insufficient food bolus formation can also be a risk factor for aspiration pneumonia, and insufficient chewing due to loss of teeth and deteriorated tongue movement in elderly people causes difficulty of food bolus formation .…”

“…The prevalence of oropharyngeal dysphagia is around 60% in nursing homes, 5,6 and aspiration of food is recognised as a risk factor for aspiration pneumonia. [7][8][9] Insufficient food bolus formation can also be a risk factor for aspiration pneumonia, and insufficient chewing due to loss of teeth and deteriorated tongue movement in elderly people causes difficulty of food bolus formation. 10,11 Without sufficient chewing, food boluses reach the pharyngeal cavity in their original condition and can increase the risk of aspiration.…”