Aspiration Pneumonia

This chapter discusses how aspiration pneumonia develops in older people and suggests preventive strategies that may reduce the incidence of pneumonia among older adults. Silent aspiration of oropharyngeal bacterial pathogens to the lower respiratory tract is one of the most important risk factors for elderly pneumonia. Impairments in swallowing and cough reflexes among older adults, for example, related to cerebral basal ganglia infarctions, increase the risk of pneumonia. Since both swallowing and cough reflexes are mediated by endogenous substance P contained in the vagal and glossopharyngeal nerves, pharmacological therapy using ACE inhibitors, which decrease substance P catabolism, can improve both reflexes and result in the lowering of the risk for pneumonia. Since the production of substance P is regulated by dopaminergic neurons in the cerebral basal ganglia, treatment with dopamine analogues or potentiating drugs such as amantadine can reduce the incidence of pneumonia.