Chronic Aspiration

Typically, chronic aspiration of oropharyngeal secretions and food affects the elderly and debilitated (e.g., cancer, neurological disorder) and institutionalized individuals who likely have swallowing difficulties (354,357,389,395,397,398). The elderly frequently have poor oral hygene, resulting in colonization of their mouths by respiratory tract pathogens (Enterobacteriaceae, Pseudomonas aeruginosa, Staphylococcus aureus [395]).

Because of the circumstances, a history of aspiration may not be elicited (377, 411,412). This is also applicable to children who may inhale a foreign body but yet are asymptomatic. Aspiration in the debilitated can be repeated, manifesting as recurrent pneumonia, episodic bronchospasm, bronchiectasis, or a lung abscess (336,337, 341,342,377,379,389,412-414). Eventual respiratory arrest can occur.

Fig. 59. Acute aspiration. (A) Area of green discoloration of lung parenchyma owing to aspiration of bilious stomach contents (delimited by arrows; see Companion CD for color version of this figure). (B) Microscopic section of lung. Aspirated material from pharynx and stomach (H&E, original magnification x100).

Fig. 59. Acute aspiration. (A) Area of green discoloration of lung parenchyma owing to aspiration of bilious stomach contents (delimited by arrows; see Companion CD for color version of this figure). (B) Microscopic section of lung. Aspirated material from pharynx and stomach (H&E, original magnification x100).

Microscopic examination of the lungs affected by chronic aspiration will reveal associated bronchiolitis, bronchopneumonia, and/or foreign body granulomatous inflammation (Fig. 61; refs. 337, 377, and 389).

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If you suffer with asthma, you will no doubt be familiar with the uncomfortable sensations as your bronchial tubes begin to narrow and your muscles around them start to tighten. A sticky mucus known as phlegm begins to produce and increase within your bronchial tubes and you begin to wheeze, cough and struggle to breathe.

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