Careful history taking detects initially unknown underlying causes of aspiration pneumonia.
aspiration
cause
differential diagnosis
dysphagia
pneumonia
Journal
Geriatrics & gerontology international
ISSN: 1447-0594
Titre abrégé: Geriatr Gerontol Int
Pays: Japan
ID NLM: 101135738
Informations de publication
Date de publication:
Aug 2020
Aug 2020
Historique:
received:
15
04
2020
revised:
19
05
2020
accepted:
07
06
2020
pubmed:
7
7
2020
medline:
17
9
2020
entrez:
7
7
2020
Statut:
ppublish
Résumé
The majority of pneumonia in the elderly is attributed to aspiration. Identifying the cause of aspiration is essential for efficient treatment and prevention. However, the methodology on how to investigate the causes is not established. Therefore, we studied cases that were initially admitted for pneumonia and were newly diagnosed with an underlying cause of aspiration. This is the first study to analyze such cases collectively. This was a retrospective study. Patients aged 65 years or older admitted for pneumonia from October 2012 to November 2018 and were newly diagnosed with a cause of aspiration after admission was included. Patients were excluded if they had hospital-acquired pneumonia, interstitial lung disease, or obstructive pneumonia or were immunocompromised. In total, 4043 patients were admitted for pneumonia and 125 cases who were newly diagnosed with causes of aspiration after admission were included in the study. This constituted 30.7% of suspected aspiration pneumonia cases in which there was no known cause of aspiration on admission. The most common conditions newly identified were neurologic disorders, upper gastrointestinal disorders, drug-induced conditions, and head and neck disease. Some were lethal. The diagnosis enabled treatment of the underlying condition and prevention of aspiration in most cases. The most common sign that lead to the diagnosis was symptoms seen from admission, followed by chronic symptoms. In 30.7% of those with suspected aspiration pneumonia with an unknown cause, a cause of aspiration was newly diagnosed. Careful history taking concerning neurological, gastrointestinal and drug-induced disorders is essential in elderly patients with pneumonia. Geriatr Gerontol Int 2020; 20: 785-790.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
785-790Informations de copyright
© 2020 Japan Geriatrics Society.
Références
Teramoto S, Fukuchi Y, Sasaki H, Sato K, Sekizawa K, Matsuse T. High incidence of aspiration pneumonia in community- and hospital-acquired pneumonia in hospitalized patients: a multicenter, prospective study in Japan. J Am Geriatr Soc 2008; 56: 577-579.
The Japanese Respiratory Society. The JRS Guidelines for the Management of Pneumonia in Adults. Tokyo: Medical Review Co, 2017. (In Japanese.).
Yoshimatsu Y, Tobino K, Maeda K et al. Management of airway obstruction due to diffuse idiopathic skeletal hyperostosis in the cervical spine: a case report and literature review. Intern Med 2019; 58: 271-276.
Alagiakrishnan K, Bhanji RA, Kurian M. Evaluation and management of oropharyngeal dysphagia in different types of dementia: a systematic review. Arch Gerontol Geriatr 2013; 56: 1-9.
Lundell LR, Dent J, Bennett JR et al. Endoscopic assessment of oesophagitis: clinical and functional correlates and further validation of the Los Angeles classification. Gut 1999; 45: 172-180.
Roden DF, Altman KW. Causes of dysphagia among different age groups: a systematic review of the literature. Otolaryngol Clin North Am 2013; 46: 965-987.
Okazaki T, Ebihara S, Mori T, Izumi S, Ebihara T. Association between sarcopenia and pneumonia in older people. Geriatr Gerontol Int 2020; 20: 7-13. https://doi.org/10.1111/ggi.13839.
Terpenning MS, Taylor GW, Lopatin DE, Kerr CK, Dominguez BL, Loesche WJ. Aspiration pneumonia: dental and oral risk factors in an older veteran population. J Am Geriatr Soc 2001; 49: 557-563.
Higashikawa T, Shigemoto K, Goshima K et al. Risk factors for the development of aspiration pneumonia in elderly patients with femoral neck and trochanteric fractures. Medicine 2020; 99: e19108.
Yoshimatsu Y, Tobino K, Sueyasu T et al. Repetitive saliva swallowing test predicts COPD exacerbation. Int J Chron Obstruct Pulmon Dis 2019; 14: 2777-2785.
Teramoto S, Yoshida K, Hizawa N. Update on the pathogenesis and management of pneumonia in the elderly-roles of aspiration pneumonia. Respir Investig 2015; 53: 178-184.
Mandell LA, Wunderink RG, Anzueto A et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis 2007; 44 (Suppl 2): S27-S72.
Woodhead M, Blasi F, Ewig S et al. Joint Taskforce of the European Respiratory Society and European Society for Clinical Microbiology and Infectious Diseases. Guidelines for the management of adult lower respiratory tract infections-full version. Clin Microbiol Infect 2011; 17 (Suppl 6): E1-E59.
Mandell LA, Niederman MS. Aspiration pneumonia. N Engl J Med 2019; 380: 651-663.