Simple two-step swallowing provocation test for elderly patients with aspiration pneumonia

Abstract

Although many pulmonologists and geriatricians recognise that silent aspiration and swallowing disorder are very important for the pathogenesis of aspiration pneumonia and nosocomial pneumonia in elderly patients, 1 Kikuchi R Watabe N Konno T et al. High incidence of silent aspiration in elderly patients with community-acquired pneumonia. Am J Respir Crit Care Med. 1994; 150: 251-253 Crossref PubMed Scopus (279) Google Scholar , 2 Teramoto S Matsuse T Ouchi Y Foreign body aspiration into the lower airways may not be unusual in older adults. Chest. 1998; 113: 1733-1734 Crossref PubMed Scopus (18) Google Scholar a videofluoroscopic examination, which is the most reliable method to detect aspiration and swallowing disorder, can not be done for all elderly patients. 3 Daniels SK Brailey K Priestly DH et al. Aspiration in patients with acute stroke. Arch Phys Med Rehabil. 1998; 79: 14-19 Summary Full Text PDF PubMed Scopus (318) Google Scholar A simple method for screening swallowing disorder may help to avoid having to refer all elderly patients to special dysphagia centres for videofluoroscopic study. However, it has been suggested that bedside clinical evaluation alone underestimates the frequency of aspiration in patients with swallowing disorder. 4 Splaingard ML Hutchins B Sulton LD Chaughuri G Aspiration in rehabilitation patients: videofluoroscopy vs bedside clinical assessment. Arch Phys Med REhabil. 1988; 69: 637-640 PubMed Google Scholar Here we show that a simple two-step swallowing provocation test was particularly useful in detecting swallowing disorder in elderly patients with aspiration pneumonia. 24 patients with aspiration pneumonia, mean age 73 (SD 4) years, had experienced an episode of observed aspiration with chest radiography evidence of an inflammatory response in a dependent pulmonary segment, with an increased white blood cell count (>10 000/mm 3 Daniels SK Brailey K Priestly DH et al. Aspiration in patients with acute stroke. Arch Phys Med Rehabil. 1998; 79: 14-19 Summary Full Text PDF PubMed Scopus (318) Google Scholar ). 24 controls, mean age 71 (3) years, had cerebral ischaemic diseases. A various degree of cerebral atrophy and lacunar infarction were found in both groups by cerebral computed tomography and magnetic resonance imaging. A simple two-step swallowing-provocation test (STS-SPT) was done on all patients. STS-SPT was estimated by the swallowing response and latent time for swallowing following bolus injection of 0·4 mL or 2·0 mL of distilled water at the suprapharynx through a small nasal catheter (internal diameter 0·5 mm) in a supine position. 5 Teramoto S, Sudo E, Matsuse T, et al. Impaired swallowing reflex in patients with obstructive sleep apnea syndrome. Chest (in press). Google Scholar The appropriate placement of catheter tip at suprapharynx was identified by visual inspection. 5 Teramoto S, Sudo E, Matsuse T, et al. Impaired swallowing reflex in patients with obstructive sleep apnea syndrome. Chest (in press). Google Scholar