Prevention of aspiration pneumonia recurrences

Aspiration pneumonia occurs after a documented aspiration or in patients with aspiration risk factors, suggesting a potential oropharyngeal portal of entry for the responsible pathogens. Strategies aimed at preventing recurrences are based on the identification of risk factors, their modification, and the implementation of appropriate corrective measures.

A comprehensive review of the literature (2000-2025) on the prevention of aspiration pneumonia was conducted.

Treatments likely to exacerbate swallowing disorders must be reassessed, particularly anticholinergics, sedatives, and psychotropic drugs. No treatment was significantly effective in directly preventing aspiration pneumonia. Nutritional requirements are met using enteral nutrition, but it increases oral bacterial colonization, oral biofilm thickness, and muscle weakness. A series of measures (semi-sitting positioning in patients with impaired awareness or enteral nutrition, speech therapy, rehabilitation, and elimination of dental biofilm) were significantly effective in preventing aspiration pneumonia. Adapting food texture and thickening liquids are measures being considered to reduce the risks, despite the potential impact on the quality of life and on nutritional intake.

A multidisciplinary assessment is recommended after an episode of pneumonia in the elderly to identify the pathogen's route of entry and to establish a plan to prevent recurrences. Future research will need to determine priorities among the various measures proposed to optimize management strategies.