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• W1566722673 abstract "To the Editor: Swallowing disorders are common and cause significant morbidity and mortality due to aspiration pneumonia in the elderly.1-4 Because it is reported that prolonged swallowing reflex is an important risk for pneumonia,3, 4 involuntary swallowing, which can regulate the quality and quantity of oropharyngeal secretions in the pharynx,1 may also be a predictor for risk of pneumonia. However, involuntary swallowing has not been studied in elderly patients at high risk for aspiration. We therefore examined the frequency of involuntary swallowing in elderly patients with aspiration pneumonia and compared the results with those in age-matched healthy controls. Furthermore, we administered angiotensin-converting enzyme (ACE) inhibitors5 and compared the pretreatment data with those after treatment in patients with aspiration pneumonia. Twenty-two institutionalized patients (13 men) were eligible for this study, with a mean age±standard deviation of 77.2±9.4. They had had at least two episodes of aspiration with chest radiographic evidence of inflammation in the lower pulmonary segments but were not bedridden. Computed tomographic scans revealed various degrees of cerebral atrophy and lacunar infarction. The 18 controls, mean age 78.4±4.5, were healthy volunteers. All subjects had been free from pneumonia for more than 2 months before this study. To eliminate diurnal variation, studies were performed at mid-interval between breakfast and lunch. Each subject refrained from taking food and water for at least 1 hour before the study. The swallowing action was identified using visual observation of the characteristic laryngeal movement and an electromyogram attached to the chin.4 Frequency of swallowing was counted while awake but at rest in a supine position over an hour. After baseline data were obtained, imidapril, an ACE inhibitor, was orally administered at 5 mg/d5 to six randomly selected patients of the 22 patients with pneumonia, and the study was repeated after 2 weeks of treatment. Mean swallowing frequency was significantly lower in patients with recurrent pneumonia than in controls (5.3±2.8 vs 18.3±9.8 times/h, respectively, P<.001) (Figure 1). Imidapril significantly increased the frequency of involuntary swallowing in all six subjects compared with pretreatment data (pretreatment 6.2±1.7 vs posttreatment 13.7±4.3 times/h; P<.02). Frequency of involuntary swallowing in controls (closed circles) and patients with aspiration pneumonia (open circles). Vertical bars indicate standard errors of the mean values. The present study demonstrated that frequency of involuntary swallowing was lower in elderly patients with aspiration pneumonia and that this might be an independent marker for an increased risk for pneumonia. Use of ACE inhibitors increases swallowing frequency and consequently augments clearance of oropharyngeal secretions, which might add an alternative beneficial mechanism for ACE inhibitor–induced reduction of aspiration pneumonia in institutionalized elderly subjects.1, 5, 6 The simple visual measurement of swallowing might be useful for evaluating swallowing functions and provide us with a chance to develop an appropriate preventive strategy for elderly aspiration pneumonia." @default.
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• W1566722673 date "2004-05-24" @default.
• W1566722673 modified "2023-10-17" @default.
• W1566722673 title "Depressed Involuntary Swallowing and Risk of Pneumonia" @default.
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• W1566722673 doi "https://doi.org/10.1111/j.1532-5415.2004.52277_11.x" @default.
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