Oropharyngeal dysphagia is a risk factor for community-acquired pneumonia in the elderly

Almirall, Jordi; Rofes, Laia; Serra‐Prat, Mateu; Icart, Roser; Palomera, Elísabet; Arreola, Viridiana; Clavé, Père

doi:10.1183/09031936.00019012

Cited by 200 publications

(151 citation statements)

References 25 publications

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“…The median quality score of the studies was 7.44 (range [5][6][7][8][9]. The median quality score of the case-control and cross-sectional studies was 7.42, which was very similar to that of the cohort studies (7.5).…”

Section: Quality Assessmentsupporting

confidence: 55%

Risk Factors for Community-Acquired Pneumonia in Adults: A Systematic Review of Observational Studies

Almirall

Serra‐Prat²,

Bolíbar³

et al. 2017

Respiration

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196

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We performed a systematic review of the literature to establish conclusive evidence of risk factors for community-acquired pneumonia (CAP). Observational studies (cross-sectional, case-control, and cohort studies) the primary outcome of which was to assess risk factors for CAP in both hospitalized and ambulatory adult patients with radiologically confirmed pneumonia were selected. The Newcastle-Ottawa Scale specific for cohort and case-control designs was used for quality assessment. Twenty-nine studies (20 case-control, 8 cohort, and 1 cross-sectional) were selected, with 44.8% of them focused on elderly subjects ≥65 years of age and 34.5% on mixed populations (participants' age >14 years). The median quality score was 7.44 (range 5-9). Age, smoking, environmental exposures, malnutrition, previous CAP, chronic bronchitis/chronic obstructive pulmonary disease, asthma, functional impairment, poor dental health, immunosuppressive therapy, oral steroids, and treatment with gastric acid-suppressive drugs were definitive risk factors for CAP. Some of these factors are modifiable. Regarding other factors (e.g., gender, overweight, alcohol use, recent respiratory tract infections, pneumococcal and influenza vaccination, inhalation therapy, swallowing disorders, renal and liver dysfunction, diabetes, and cancer) no definitive conclusion could be established. Prompt assessment and correction of modifiable risk factors could reduce morbidity and mortality among adult CAP patients, particularly among the elderly.

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Section: Quality Assessmentsupporting

confidence: 55%

Risk Factors for Community-Acquired Pneumonia in Adults: A Systematic Review of Observational Studies

Almirall

Serra‐Prat²,

Bolíbar³

et al. 2017

Respiration

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196

151

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“…Oropharyngeal dysphagia (OD) is a common major complaint in daily medical practice, occurring in 20-23% of older persons who live an independent life [1,2]. This condition is considered to be an important causative factor of aspiration pneumonia [3].…”

Section: Introductionmentioning

confidence: 99%

Effects of Capsaicin on Older Patients with Oropharyngeal Dysphagia: A Double-Blind, Placebo-Controlled, Crossover Study

Nakato¹,

Manabe²,

Shimizu

et al. 2017

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Background/Aims: The standard of care for older patients with oropharyngeal dysphagia (OD) is poor. Stimulation of transient receptor potential vanilloid 1 might become a pharmacological strategy for these patients. This study aimed to compare the therapeutic effect of film food containing 0.75 µg of capsaicin in these patients. Methods: In a crossover, randomized trial, 49 patients with OD were provided capsaicin or identical placebo at least 7 days apart. Patients' reported symptoms during repeated swallowing, the volume, pH and substance P (SP) concentrations in saliva, and cervical esophageal wall motion evaluated by ultrasonographic tissue Doppler imaging were obtained before and after capsaicin or placebo administration. Results: Significantly more patients with OD who took capsaicin experienced improvement in symptoms than those who took placebo. Salivary SP levels were significantly increased after capsaicin administration compared with placebo in the effective group. The duration of cervical esophageal wall opening was significantly shorter in capsaicin administration in the effective group. Furthermore, a significant negative correlation was found between the duration of cervical esophageal wall opening and salivary SP levels. Conclusion: Elevated salivary SP concentrations stimulated by capsaicin greatly improve the safety and efficacy of swallowing, and shorten the swallow response in older patients with OD.

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“…Dysphagia and swallowing dysfunction are widely accepted as risk factors for pneumonia, especially in aspiration pneumonia [16,17,20,[26][27][28]; furthermore, a number of studies have shown that regular visits to the dentist and good oropharyngeal hygiene are protective against CAP [3,21,29]. In a small, case-controlled prospective study, patients with swallowing dysfunction had increased episodes of recurrent pneumonia [11], although these results were not replicated in larger studies [9,10].…”

Section: Clinical Risk Factorsmentioning

confidence: 97%

“…Chronic respiratory diseases [23][24][25], dysphagia and poor oral hygiene [3,16,17,20,21,[26][27][28][29], stroke and associated neurological dysfunction, heart failure, and certain immune deficiency states and systemic diseases (e.g., chronic renal or liver disease) may all increase the risk of incidence CAP by twoto fourfold [3]. COPD, in particular, has been widely studied and established as an important risk factor for incident pneumonia.…”

Section: Clinical Risk Factorsmentioning

confidence: 99%

Recurrent Pneumonia: A Review with Focus on Clinical Epidemiology and Modifiable Risk Factors in Elderly Patients

et al. 2014

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Community-acquired pneumonia (CAP) is one of the most common reasons for physician visits and hospitalizations in North America. Rates of CAP increase with age and CAP is associated with significant morbidity and mortality, especially in the elderly. Though there is much written about the epidemiology and risk factors of incident (first episode) pneumonia, much less is known about recurrent pneumonia. Rates of recurrent pneumonia within 3-5-years of an episode of CAP are 9-12% with a median time to recurrence of 123-317 days and mortality ranging from 4 to 10%. Age ≥65-years-old and impaired functional status are the only patient characteristics that are independently associated with increased risk of recurrence. In terms of modifiable risk factors, only the use of proton-pump inhibitors and systemic and inhaled corticosteroids have consistently been associated with increased risk of recurrent pneumonia, while angiotensin-converting enzyme (ACE) inhibitors may exert a protective effect. Many chronic medical conditions typically associated with increased incident pneumonia-such as chronic obstructive pulmonary disease (COPD), neurological disease (resulting in dysphagia or silent aspiration), and heart failure-were not associated with increased risk of recurrent pneumonia. However, those who are immune-suppressed (e.g., immunoglobulin deficiencies) may be at increased risk of recurrent pneumonia. In summary, among those who survive an episode of pneumonia, recurrence is not uncommon, particularly in the elderly. Following recovery from an episode of pneumonia, patients should be evaluated for risk factors that would predispose to a second episode including seeking evidence of immunosuppression in younger patients and medication optimization, particularly in the elderly.

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Oropharyngeal dysphagia is a risk factor for community-acquired pneumonia in the elderly

Cited by 200 publications

References 25 publications

Risk Factors for Community-Acquired Pneumonia in Adults: A Systematic Review of Observational Studies

Risk Factors for Community-Acquired Pneumonia in Adults: A Systematic Review of Observational Studies

Effects of Capsaicin on Older Patients with Oropharyngeal Dysphagia: A Double-Blind, Placebo-Controlled, Crossover Study

Recurrent Pneumonia: A Review with Focus on Clinical Epidemiology and Modifiable Risk Factors in Elderly Patients

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