Aspiration is when a foreign substance is inhaled into the airway and lower respiratory tract. Respiratory symptoms can occur following aspiration, depending on factors such as the amount, consistency (whether it is a hard food, liquid, oil, or stomach acid), pH level (how acidic or basic it is), frequency, and reaction to the foreign substance.

Who is at Risk of Aspiration?

  • The elderly.
  • Those with a history of surgery around the pharynx, such as at the base of the tongue, for pharynx cancer, for larynx cancer, etc.
  • Those with disorders of the nervous or musculoskeletal systems, such as difficulty swallowing.
  • Those with a history of surgery to the face and neck, who have undergone radiation, or who have respiratory disease.
  • Those suffering from stroke, Alzheimer’s disease, Parkinson’s disease, demyelinating disease, spinal injury, or using general anesthesia.
  • Those under the influence of alcohol, affecting consciousness, or anxiety medication.

Signs and Symptoms of Aspiration

  • Inability to swallow or taking too long to swallow (normally it takes one second to swallow).
  • Coughing or gagging while drinking water or for longer than one minute.
  • Crackling noise in the throat after drinking water.
  • After drinking water, there is still water remaining in the mouth or the inside of the cheeks.
  • Inability to swallow water.
  • Inability to control saliva, causing drooling.

Prevention of Aspiration

  • Sit up straight while eating and avoid a reclined or lying down position. If the patient is confined to the bed, raise the head to at least 60-90 degrees to prevent aspiration. Avoid going to bed immediately after a meal.
  • Tilt head forward slightly when swallowing to prevent aspiration in person who has difficulty swallowing.
  • Eat small bites of food and chew slowly and completely before swallowing.
  • Concentrate on swallowing when eating and do not talk or laugh while eating.
  • Do not rush when eating. Make adequate time for each meal. If a patient requires feeding, do not feed them too quickly. Notice them chewing and swallowing before offering another bite. Serve appropriate portions that the patient can chew easily.
  • Avoid eating when tired as this can cause aspiration.
  • Eat a mix of textures, such as harder, chewable foods and soft or liquid foods.
  • Avoid sticky foods that are hard to chew as they can get stuck in the throat. Big pieces of good should be chopped or diced.
  • Cook food until soft. Meat should be cut as small as possible. If vegetables are served, ensure they are cut into small pieces and cooked until soft.
  • Choose the thickness of the food according to the person’s ability to swallow it. Some patients may be better able to swallow thicker liquids than thinner. For patient with difficulty swallowing, adjust the texture of food by adding a thickener to certain liquids as needed to reduce the risk of aspiration.
  • Do not eat food that is too dry. Make sure there is sauce or soup so the food is moist and soft.
  • The environment during meals should be quiet. Avoid talking, watching television, etc.
  • Maintain good oral hygiene and clean the mouth after every meal to reduce the collection of bacteria in the mouth, which can prevent infection from aspiration.

Prevention of Aspiration in Tube-Fed Patients

  • For the patient at higher risk of aspiration, such as one who has more than 200 milliliters of residual food in their stomach, opt for continuous feeding. This is more effective in preventing aspiration than bolus feeding, which a larger meal is given in a short period.
  • Raise the head of the bed to at least 30 degrees during the continuous tube feeding.
  • Always check the position of the feeding tube before meals to prevent aspiration.
  • For the patient who requires continuous tube feeding, check the residual food in their stomach every four to six hours and before the next meal. If the residual amount is more than 200 milliliters, delay the next meal.