Inhalation Therapy with Nebulized Capsaicin in a Patient with Oropharyngeal Dysphagia Post Stroke: A Clinical Case Report.

Anna Maria Pekacka-Egli,Wolfram Windisch,Jana Herrmann,Marc Spielmanns,Katharina Schulz,Stefan Tino Kulnik,Arthur Goerg,Eveline Zenker

doi:10.3390/geriatrics7020027

Abstract

Dysphagia and aspiration risk are common sequelae of stroke, leading to increased risk of stroke-associated pneumonia. This is often aggravated by stroke-related impairment of cough, the most immediate mechanical defense mechanism against aspiration. In humans, reflex cough can be repeatedly and safely elicited by inhalation of nebulized capsaicin, a compound contained in chili peppers. Could this cough-eliciting property of capsaicin support the recovery of stroke survivors who present with dysphagia and aspiration risk? We present a clinical case report of a 73-year-old man, admitted to inpatient stroke rehabilitation following a right middle cerebral artery infarct with subsequent dysphagia and hospital-acquired pneumonia. A course of daily inhalation therapy with nebulized capsaicin was initiated, triggering reflex coughs to support secretion clearance and prevent recurrence of pneumonia. Clinical observations in each inhalation therapy session demonstrate good patient response, safety and tolerability of nebulized capsaicin in this mode of application. Repeated Fiberoptic Endoscopic Evaluation of Swallowing (FEES) assessments show concurrent improvement in the patient’s swallowing status. Inhalation therapy with nebulized capsaicin may offer a viable treatment to facilitate coughing and clearing of secretions, and to minimize aspiration and risk of aspiration-related pneumonia post stroke. Further investigation in a randomized controlled trial design is warranted.

Highlights

Stroke is considered the second leading cause of death worldwide and is the most common cause of severe disability after the age of 40 [1,2]
It has been reported that dysphagic stroke survivors are at an approximately three-fold risk of developing pneumonia compared to non-dysphagic stroke survivors, and those with confirmed aspiration exhibit an eleven-fold risk compared to non-aspirators [7]
Incorporated into post-stroke care and rehabilitation, inhalation therapy with nebulized capsaicin may thereby contribute to dysphagia management and the prevention of aspiration-related pneumonia. In this clinical case report, we present the application of a course of inhalation therapy with nebulized capsaicin during inpatient rehabilitation of a patient with oropharyngeal dysphagia and high aspiration risk post stroke

Summary

Introduction

Stroke is considered the second leading cause of death worldwide and is the most common cause of severe disability after the age of 40 [1,2]. Reported incidence rates for post-stroke dysphagia range from 8% to 80%, depending on the definition of dysphagia and the method of its detection [4]. A common complication of dysphagia is the aspiration of food, drink, saliva or stomach contents into the lower airways, leading to increased risk of stroke-associated pneumonia (SAP) [5,6]. Dysphagia screening and clinical swallowing assessment followed by appropriate clinical management strategies can reduce aspiration and subsequently lower the risk of pneumonia post stroke [8]. It is important to note, that often screening is focused only on dysphagia without consideration of aspiration and vice-versa. This could be misleading, because dysphagia can occur without aspiration [9]. High sensitivity bed site evaluations (BSE) designed to detect aspiration and tested against

Results

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Conclusion