There’s probably been a time when you swallowed some food or drink and it felt like it went down the wrong pipe. That’s when a bit of food or liquid may have headed toward your lungs rather than your stomach. Most of the time when this happens, you’ll cough, and the food or liquid will clear out of your airway. But sometimes, it can reach your lungs and develop into a type of pneumonia called aspiration pneumonia.
You can also develop aspiration pneumonia from breathing in saliva or acid from your stomach that moves up your esophagus due to reflux. Everyone has some level of reflux, where stomach acid regurgitates into the esophagus. But if your reflux is bad enough to wake you up at night, it can cause chronic lung problems that could worsen into pneumonia over time.
And people who lose consciousness and vomit could also develop it. “If you don’t cough it out, you can develop aspiration pneumonia,” said Jason McCarl, MD, a pulmonologist with Banner Health Clinic in Northern Colorado.
What are the symptoms of aspiration pneumonia?
Similar to any pneumonia, symptoms of aspiration pneumonia include fever, shortness of breath/difficulty breathing, chest pain from the inflammation and a cough that’s usually productive. Another condition known as aspiration pneumonitis can occur when similar events take place, resulting in inflammation and irritation without an infection.
Who’s at risk for aspiration pneumonia?
Older adults are at higher risk of developing aspiration pneumonia, since it can become harder to swallow properly as you age. Swallowing might seem simple—even newborn babies can do it—but it’s not. “Swallowing is a very sophisticated process that requires coordination of several different muscles in your throat. Over time those muscles can deteriorate. That’s why aging puts you at risk,” Dr. McCarl said. If you've had a stroke or another neurological condition, this will increase your risk.
Others at risk include people with reduced consciousness. Conditions such as intoxication, anesthesia, sedation, or neurological disorders can impair the gag reflex, making it more likely for substances to enter the lungs. Additionally, people with certain medical conditions like chronic lung disease (e.g., COPD), weakened immune systems, and conditions that affect swallowing or increase the risk of reflux can heighten the risk of aspiration pneumonia.
“It all comes down to the swallowing mechanisms and protecting your airways,” Dr. McCarl said. “If you can’t protect your airways from secretions going into your lungs, or the muscles that control swallowing don’t work properly, you can end up getting aspiration.”
How can you prevent aspiration pneumonia?
If you’re at risk for aspiration pneumonia, a speech therapist can do swallowing studies to identify ways to lower your odds of developing this medical condition. They can recommend a diet that focuses on foods you’re less likely to aspirate or inhale, based on their consistency. They can also recommend techniques like tucking your chin when you swallow, taking small bites and not drinking from a straw.
If you aspirate at night because of reflux, antacids can help. “We all have reflux—that’s part of how our bodies work. But if you have excessive amounts, antacids can reduce the number of times you experience reflux,” Dr. McCarl said.
Elevating the head of your bed can also help reduce reflux. Dr. McCarl recommends putting blocks under the bedposts, so the mattress stays flat but on an angle. You can also use a pillow or wedge to elevate your head and shoulders.
If you develop pneumonia and you’re elderly, or you have a history of stroke or neuromuscular disease, doctors may recommend a chest X-ray. If the X-ray shows pneumonia in your right lower lung, there’s a good chance it’s aspiration pneumonia. That’s where whatever you aspirated tends to end up, because of the design of your lung anatomy. A speech therapist can also perform a swallowing evaluation to see if you’re coughing when you’re eating or drinking.
Diagnosis and treatment of aspiration pneumonia
Fluoroscopy—a continuous X-ray that can look for signs that food or fluid could enter your lungs—is the most definitive test for aspiration pneumonia.
If you’re diagnosed with aspiration pneumonia, your doctor will probably prescribe antibiotics to treat it. And you can take the prevention steps outlined above to make sure it doesn’t happen again. Most people who are treated for aspiration pneumonia will survive. However, untreated aspiration pneumonia can be dangerous and potentially fatal, and can lead to complications like lung abscesses and scarring.
The bottom line
If you breathe in or aspirate food or fluids, you could be at risk for aspiration pneumonia. If you have swallowing problems or reflux, your odds of developing it are higher, but you can take steps to reduce the risk of aspiration pneumonia. If you’d like to connect with a pulmonologist to learn more about your risk, reach out to Banner Health.
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