What Is Aspiration Pneumonia? Doctors Explain Symptoms, Causes, and Treatments


There are two types of pneumonia that commonly come to mind when talking about the condition: viral pneumonia (pneumonia caused by a virus) and bacterial pneumonia (pneumonia caused by bacteria). But the lung infection can be caused by much more than just viral or bacterial intruders—and sometimes, it may not be caused by germs (aka microbes) at all; at least not at first.

Aspiration-Pneumonia-Still-GettyImages-97236469 Aspiration-Pneumonia-Still-GettyImages-97236469 are caused by a viral or bacterial infection that leads to inflammation in the lungs (specifically the air sacs or alveoli which fill with fluid or pus), aspiration pneumonia occurs when food or liquids (including saliva and vomit) are inhaled (or aspirated) instead of swallowed.

To the lungs, those substances are foreign. Sometimes, the aspiration clears up on its own; other times, it can lead to a bacterial infection. "First, you get inflammation, usually a day or two after you aspirate," Nicola Hanania, MD, a pulmonary and critical care physician at the Baylor College of Medicine, tells Health. Then, Dr. Hanania says, it turns into bacterial pneumonia "most of the time."

RELATED: Is Pneumonia Contagious? What to Know, and How to Protect Yourself

What are the symptoms of aspiration pneumonia?

The symptoms of aspiration pneumonia are the same as the signs for other forms of pneumonia, Dr. Casciari says. According to the National Library of Medicine's MedlinePlus resource, those include:

  • Chest pain
  • Coughing up greenish or dark phlegm or phlegm that contains pus or blood
  • Fatigue
  • Fever
  • Shortness of breath
  • Wheezing
  • Smelly breath
  • Excessive sweating
  • Problems with swallowing
  • Confusion

What causes aspiration pneumonia?

There's a laundry list of potential causes and risk factors for aspiration pneumonia. Marc A. Sala, MD, assistant professor of pulmonary and critical care medicine at the Northwestern Medicine Feinberg School of Medicine, tells Health that the condition is more likely to happen in older people or those who are immunocompromised. "When one's physical or immune defenses are impaired, as they can be with old age or certain neurological diseases, aspiration can become a problem and lead to infection," he says.

Dr. Casciari lists off other potential causes, including being hit in the stomach, having a hiatal hernia (a condition where part of the stomach pushes up through the diaphragm muscle), and even being intoxicated as leading to aspiration pneumonia. "One of the worst cases I've ever had of aspiration pneumonia was a young man who got drunk and passed out at a fraternity party," he says. "All of your natural refluxes that protect your airway are hampered when you're drunk. He vomited and it made its way down to the lungs—and he got incredibly sick."

According to MedlinePlus, these factors can raise your risk of aspiration pneumonia:

  • Being less alert due to medicines, illness, surgery, or other reasons
  • Being in a coma
  • Drinking large amounts of alcohol
  • Receiving general anesthesia for surgery
  • Old age
  • Poor gag reflex in people who are not alert after a stroke or brain injury
  • Problems with swallowing

RELATED: Viral vs. Bacterial Pneumonia: What's Really the Difference?

How is aspiration pneumonia diagnosed and treated?

Diagnosis usually starts with a healthcare provider listening to your chest with a stethoscope for the sound of crackling or unusual breathing sounds. They may also tap on the wall of your chest to listen and feel for abnormal sounds in your chest, Medline Plus says. If your doctor suspects you have pneumonia, they'll likely order a chest X-ray.

From there, it depends on how severe the aspiration pneumonia is, regarding treatment. "Treatment is almost always antibiotics," Sala says. Your doctor also may recommend positions you can lay in, to help drain your lungs, Dr. Casciari says.

In more severe cases of aspiration pneumonia, people need to be hospitalized and sometimes put on a ventilator to help with breathing. Those with more severe cases are also at a greater risk of developing complications, including lung abscess, shock, the spread of the infection to other areas of the body, including the bloodstream, respiratory failure, and death, Medline Plus says.

"Most of the time, [aspiration pneumonia is] treated well with antibiotics," Dr. Hanania says. A lot of how well someone does with the condition depends on factors like their health before getting pneumonia, the type of bacteria that caused the pneumonia, and how much of the lungs are involved, Dr. Casciari says.  

How can you prevent aspiration pneumonia?

If you develop aspiration pneumonia, you may be more likely to develop it again, so your doctor will want to try to figure out why it happened so you can avoid future issues. "Attempts at preventing it from occurring again in the future are key to avoiding long term damage to the lung tissue," Dr. Sala says.

If you have a condition like reflux, your doctor may recommend keeping the head of your bed elevated while you sleep, to help keep your stomach contents where they belong, Dr. Hanania says. If you have a swallowing problem, you may benefit from speech therapy, he says.

And, Dr. Casciari says, you want to be cautious of using things like alcohol, opiates, and tranquilizers. "These sedative-like drugs will affect your body's ability to control itself—and that can raise your risk of aspiration pneumonia," he says.

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