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aspiration

as·pi·ra·tion / ˌaspəˈrāshən/ • n. 1. ( usu. aspirations ) a hope or ambition of achieving something: he had nothing tangible to back up his literary aspirations. ∎  the object of such an ambition; a goal: fabrics and oriental rugs were my aspirations. 2. the action of pronouncing a sound with an exhalation of breath. 3. Med. the action of drawing fluid by suction from a vessel or cavity. DERIVATIVES: as·pi·ra·tion·al / -shənl/ adj. (in sense 1).

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aspiration

aspiration (ass-per-ay-shŏn) n. the withdrawal of fluid from the body by means of suction. vacuum a. a method of terminating pregnancy by suction of the products of conception through an intrauterine cannula. See also (aspiration) cytology, endometrial (aspiration).

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Aspiration

Aspiration

Definition

Aspiration refers to the act of inhaling, or breathing in, a foreign material. The material may include liquid, food, medicine, saliva, vomit, or mucus.

Description

When breathing, only air normally goes through the trachea, or windpipe, to the lungs. Any material at the back of the throat, such as food and liquids, is swallowed and goes to the esophagus, which is located just behind the windpipe. Breathing and swallowing normally are automatic, as is the process that prevents food, liquid, or foreign bodies in the throat from going down the windpipe and into the lungs. Both functions are complex and when something goes wrong, the normal coordination of swallowing with breathing is lost and aspiration can occur. When foreign matter goes into the lungs and damages or blocks them, the lungs swell and fluid builds up, which can cause an infection. This is called aspiration pneumonia .

The word aspiration can mean drawing up or suction. It may be used in medical terms to talk about certain kinds of procedures, such as needle aspiration biopsies, where tissue is aspirated, or drawn up, through a needle. Sometimes, fluids from a patient's lungs are aspirated, and removed.

Demographics

Many elderly people are at risk for aspiration because of conditions they have that make swallowing more difficult or weaken the gag reflex. Dysphagia, or difficulty swallowing, can lead to aspiration. A number of conditions and diseases that occur in older people can lead to swallowing difficulties. Patients who are unconscious because of a medical condition, receiving enteral nutrition (tube feeding), or undergoing anesthesia have a higher risk of aspiration. Aspiration is rare in anesthesia use, only occurring in one to five per 10,000 cases. Aspiration occurs in about 40% to 50% of stroke patients who have swallowing difficulties.

Causes and symptoms

As people age, they may not produce as much saliva as they once did because of oral and dental disease or as a side effect of medications. Stroke is more common as people get older, and stroke can cause impaired gag reflex with resulting swallowing problems . Breathing disorders more common in the elderly such as chronic obstructive pulmonary disease also can cause aspiration. Additional causes of aspiration include gastroesophageal reflux disease , surgery, throat or vocal cord defects, and laughing or inhaling with food or liquids in the mouth.

The main sign of aspiration is choking or coughing before or after swallowing. Wheezing or shortness of breath that comes on suddenly may indicate aspiration. Signs of swallowing problems include drooling, food being left over in the mouth after swallowing, pain or the feeling of something being stuck in the throat when swallowing.

Diagnosis

A speech and language pathologist may become involved in diagnosing swallowing difficulties and may participate, along with a radiologist, in an exam called a videofluoroscopic swallow study. In the study, a patient swallows liquids and foods of varying thickness mixed with barium, a substance that helps make the swallowed materials show up on the x-ray. Fluoroscopy is a sort of moving x-ray that can take moving or still images to try and show where and when swallowing problems occur and if barium enters the windpipe. Patients may be asked to place their head and neck in various positions to improve swallowing. A newer technique called fiberoptic endoscopy is being used by some physicians. This procedure involves inserting a flexible scope with a tiny camera in the throat. A chest x-ray might be performed to diagnose aspiration pneumonia.

QUESTIONS TO ASK YOUR DOCTOR

  • What types of foods or medicines should I avoid?
  • Are there certain ways I should tilt my head when I chew to prevent aspiration?
  • Are there tongue or mouth exercises that may be helpful?

Treatment

Often, no treatment is required for aspiration if no lung symptoms or problems develop. If a patient's aspiration involved larger foreign bodies, they may have to be removed, usually through bronchoscopy . A patient under anesthesia who has aspiration may require extra oxygen and support with a ventilator. If aspiration causes pneumonia, these breathing therapies and others continue. A patient is also treated with antibiotics and steroid therapy.

Nutrition/Dietetic concerns

A person who has difficulty swallowing without aspirating needs to follow a clinician's advice on therapies and may need to avoid foods or medicines that are difficult to swallow.

Therapy

People with swallowing disorders may receive therapy from a number of health care professionals, including speech and language pathologists, occupational therapists, and dietitians to help them learn new ways to chew and swallow to lower risk of aspiration.

Prognosis

Depending on the circumstances and the patient's overall health, aspiration can be serious and life-threatening, as can aspiration pneumonia. Pneumonia risk and prognosis is worse for people over age 50.

KEY TERMS

Bronchoscopy —A test used to view the throat, larynx, trachea, and lungs. A long, narrow, instrument called a bronchoscope is passed through the patient's mouth or nose to view the different parts of the airway.

Fiberoptic endoscopy —A test used to evaluate swallowing. A flexible scope is passed into the hypopharynx, the bottom portion of the throat or through the nose to view the desired structures involved in swallowing.

Prevention

Managing diet and swallowing disorders can prevent aspiration. Some people are taught how to exercise their tongues or to hold their head and chin to improve swallowing. Changing the texture or temperature of foods and limiting the amount of food placed in the mouth at one time can help prevent aspiration. Risk of aspiration during anesthesia is less if patients fast prior to surgery.

Caregiver concerns

Care givers can ensure that patients who are prone to aspiration are careful when swallowing and that those they care for get adequate nutrition and liquids. Care givers should watch carefully for signs of pneumonia or return of pneumonia. Those who care for elderly people who have had a stroke or have other nervous system disorders should be alert for signs of aspiration.

Resources

PERIODICALS

Marik, Paul E., and Danielle Kaplan. “Aspiration Pneumonia and Dysphagia in the Elderly.” Chest 124 (July 2003): 328–336.

Wiggins, Sharee A. “Pulmonary aspiration.” Clinical Reference Systems (May 31, 2007).

ORGANIZATIONS

National Heart, Lung, and Blood Institute, P.O. Box 30105, Bethesda, MD, 20824-0105, (301) 592-8573, (240) 629-3246, [email protected], www.nhlbi.nih.gov.

National Institute of Neurological Disorders and Stroke, P.O. Box 5801, Bethesda, MD, 20824, (301) 592-8573, (800) 352-9424, (301) 496-6751, www.ninds.nih.gov.

Teresa G. Odle

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"Aspiration." The Gale Encyclopedia of Senior Health: A Guide for Seniors and Their Caregivers. . Encyclopedia.com. 20 Aug. 2018 <http://www.encyclopedia.com>.

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"Aspiration." The Gale Encyclopedia of Senior Health: A Guide for Seniors and Their Caregivers. . Retrieved August 20, 2018 from Encyclopedia.com: http://www.encyclopedia.com/caregiving/encyclopedias-almanacs-transcripts-and-maps/aspiration

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