Aspiration Pneumonia After a Stroke

Aspiration pneumonia can be a serious complication after a stroke. Aspiration pneumonia is an infection of the lungs or the bronchi that happens when a person gets saliva, food or liquid into the lungs or bronchi- where these materials do not belong. These materials can get into the lungs because some stroke survivors experience weakness of the swallowing muscles as a result of the stroke, making them prone to choking.

This causes a tendency for food or liquid to 'go down the wrong pipe.' 

What is aspiration pneumonia? 

Pneumonia is a lung infection. Aspiration pneumonia is a lung infection that started because something that was supposed to go down the throat to the stomach got into the lungs instead, and then caused an infection in the lungs. When materials such as food or liquid lodge in the lungs and become infected, the resulting infection is called aspiration pneumonia. Aspiration pneumonia may cause a fever, coughing and trouble breathing. And, because it is an infection, it causes the usual symptoms of bodily infections, such as overall fatigue, loss of energy and often, loss of appetite and weight loss. Other complications that can develop during or shortly after an episode of aspiration pneumonia include blood clots and bedsores from being 'stuck in bed' with pneumonia. 

When a stroke survivor gets an infection such as aspiration pneumonia, the infection often causes a temporary exacerbation of stroke symptoms because a stroke survivor cannot function at his best when he has an infection.

Sometimes, after recovering from an episode of aspiration pneumonia, a stroke survivor may experience a long-term deterioration of stroke symptoms and an overall decline of neurological function. In severe situations, aspiration pneumonia can even contribute to another stroke. 

Who gets aspiration pneumonia?

Trouble swallowing after a stroke is the biggest risk factor for aspiration pneumonia.

Many stroke survivors have trouble swallowing or frequently choke on food and drinks while eating or drinking. Some stroke survivors may even choke on saliva while speaking, quietly resting or sleeping. 

There are a few risk factors that make it more likely for a stroke survivor to develop aspiration pneumonia after a stroke. Stroke survivors who are older are more likely to develop aspiration pneumonia than stroke survivors who are younger. Also, people who have a stroke that affects the left side of the brain are more prone to aspiration pneumonia than people who have a stroke that affects the right side of the brain. There have been several documented differences between a right-sided stroke and a left-sided stroke, and it appears that the risk of aspiration pneumonia is another one of those differences. 

When do stroke survivors get aspiration pneumonia?

Aspiration pneumonia can affect a stroke survivor any time after a stroke. If the muscles that control swallowing remain weak for months or years after a stroke, there is a risk that aspiration pneumonia can occur.

What can you do to prevent aspiration pneumonia?

Aspiration pneumonia is a known complication after a stroke, and it can be a tough infection to recover from. So it is important to be aware of the risk and to take the necessary steps to try to prevent yourself from getting aspiration pneumonia.

After a stroke, you might be given a referral for a ‘speech and swallow study.’ Many stroke survivors think that it is too much trouble to go through with the speech and swallow appointment, and postpone it or skip it altogether. However, even if you don't notice an obvious problem with your speech, it is really important to make sure that you proceed with your speech and swallow evaluation because it can identify any subtle problems that you might have with your swallowing muscles or swallowing coordination, even if you have not noticed it.

And, an even more important way for you to prevent aspiration pneumonia is by getting speech and swallow therapy, because this includes targeted swallowing exercises that can help you better coordinate your swallowing for more safety while you eat. Having stronger swallowing muscles is also important to help you avoid aspirating on saliva. In the long run, speech and swallow physical therapy is the most effective method you can use to prevent yourself from getting aspiration pneumonia after a stroke.

Sources:

Relationship between Dysphagia, National Institutes of Health Stroke Scale Score, and Predictors of Pneumonia after Ischemic Stroke, Ribeiro PW, Cola PC, Gatto AR, da Silva RG, Luvizutto GJ, Braga GP, Schelp AO, de Arruda Henry MA, Bazan R, Journal of Stroke and Cerebrovascular Disease, September 2015

Cerebral infarction in the left hemisphere compared with the right hemisphere increases the risk of aspiration pneumonia, Yamamoto K, Koh H, Shimada H, Takeuchi J, Yamakawa Y, Kawamura M, Miki T, Osaka City Medical Journal, December 2014

A pilot study of respiratory muscle training to improve cough effectiveness and reduce the incidence of pneumonia in acute stroke: study protocol for a randomized controlled trial, Kulnik ST, Rafferty GF, Birring SS, Moxham J, Kalra L, Trials, April 2014

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