Marc Holland
Pneumonia is a common complication after a stroke, with one in three stroke survivors developing it during their recovery. The primary cause of pneumonia after a stroke is dysphagia, which refers to difficulty swallowing. This condition is caused by weakness of the muscles in the mouth and throat. When an area of the brain is affected by a stroke, that area can become damaged and lose its functions, including muscle activation. This can lead to aspiration pneumonia, which occurs when a person accidentally inhales a foreign substance, such as food or liquid, leading to a serious infection in the lungs.
Aspiration is usually accompanied by fits of coughing and wheezing as the body tries to force the foreign objects out of the lungs. However, many stroke patients do not have this cough reflex due to the injury caused to their brain, and they may aspirate food and water without even feeling it or coughing it up. This is called silent aspiration and can be extremely dangerous, causing serious cases of pneumonia.
Doctors diagnose pneumonia by looking for signs such as decreased airflow, rapid heart rate, and abnormal sounds in the lungs. Treatment includes a course of antibiotics for mild cases, while more severe cases may require hospitalization, supplemental oxygen, steroids, and, in extreme circumstances, the help of a ventilator to breathe.
The best way to minimize the risk of pneumonia after a stroke is to treat dysphagia. If the stroke survivor can improve their swallowing abilities, they can reduce aspiration and prevent infections. Working with a speech therapist, trying electrical stimulation, and considering Botox injections are all effective ways to treat dysphagia and prevent aspiration pneumonia. In addition, compensation techniques such as drinking thick liquids, sitting up straight, eating slowly, avoiding complex foods, and reducing distractions can help minimize aspiration risk.
| Characteristics | Values |
|---|---|
| Prevalence of lung infection in stroke patients | Up to one-third of stroke patients suffer from pneumonia |
| Effect on mortality | Pneumonia causes the highest attributable mortality of all medical complications following stroke |
| Risk factors | Age >65, dysarthria or no speech due to aphasia, modified Rankin Scale ≥4, abbreviated mental test score <8, and a failed bedside progressive water swallow test |
| Symptoms | Cough producing a putrid, foul-tasting sputum (may be streaked with blood, or appear as a frothy fluid), shortness of breath (i.e., chronic low-grade dyspnea), fever, and weight loss |
| Treatment | Antibiotics, steroids, supplemental oxygen, suction, and in extreme circumstances, the use of a ventilator |
| Prevention | Work with a speech therapist, try electrical stimulation, consider Botox injections, and use compensation techniques while eating with dysphagia |
What You'll Learn
- Pneumonia is a common complication of stroke
- Dysphagia is a common cause of pneumonia after a stroke
- Aspiration pneumonia is caused by inhaling mouth secretions, stomach contents, or both
- Aspiration pneumonia can be prevented by improving swallowing abilities
- A speech-language pathologist can help patients improve their dysphagia
Pneumonia is a common complication of stroke
Pneumonia is a common complication following a stroke.
Pneumonia is a serious and common complication following an acute ischemic stroke. It is one of the most problematic complications, with a high mortality rate. It occurs in 4-10% of patients experiencing a stroke.
Dysphagia is a common complication after a stroke and is associated with the development of pneumonia. Dysphagia occurs when there is difficulty in the passage of food or liquid from the mouth through the pharynx, oesophagus, and stomach. It can occur in any of the four phases (oral preparatory, oral, pharyngeal, and oesophageal). The risk of aspiration pneumonia is increased by dysphagia. Aspiration pneumonia is defined as pneumonia with pre-existing risk factors, such as coughing or a wet-sounding voice during or after eating.
Stroke-induced immunodeficiency may promote bacterial infections, especially aspiration pneumonia. A complex relationship between infection and inflammatory responses may exist before and after a stroke. A combination of brain-induced immunosuppression, aspiration, and dysphagia may trigger pneumonia in the acute phase after a stroke.
The risk of pneumonia is also increased by severe hypertension, which is one of the most important risk factors for developing stroke-associated pneumonia. Other risk factors for developing pneumonia in stroke patients include recumbency, malnutrition, tube feeding, severe dysphagia, and female sex.
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Dysphagia is a common cause of pneumonia after a stroke
Dysphagia is a common complication following a stroke, affecting 30-65% of patients. It is characterised by difficulties in the passage of food or liquid from the mouth through the pharynx, oesophagus, and stomach. This can occur in any of the four phases of swallowing: oral preparatory, oral, pharyngeal, and oesophageal.
Dysphagia is a significant risk factor for pneumonia after a stroke. The presence of dysphagia in stroke patients may cause poor dietary intake, dehydration, malnutrition, and pulmonary complications, which can lead to a poor prognosis. Pneumonia is the leading cause of death during the acute phase of a stroke, with a 30-day mortality rate of 30%.
The early diagnosis and treatment of dysphagia in stroke patients are crucial to prevent stroke-associated pneumonia. Stroke patients with clinical signs of dysphagia should be thoroughly assessed and provided with appropriate treatment options.
Dysphagia can cause aspiration, which is often silent, leading to aspiration pneumonia. Aspiration pneumonia is defined as pneumonia with pre-existing risk factors, such as coughing or a wet-sounding voice during or after eating. Aspiration pneumonia is the most serious complication associated with tube feeding.
The risk of aspiration pneumonia is significantly higher in stroke patients with dysphagia than in those without. The mortality risk is also significantly higher in the former group within the first year, three years, and five years after a stroke.
Post-stroke pneumonia is often due to aspiration. Ill hospitalised patients routinely aspirate, and patients with impaired swallowing due to neurological injury are at especially high risk. Normal swallowing involves multiple complex and coordinated interactions involving the central and peripheral nervous systems.
The pharyngeal phase of the swallowing process is usually associated with a risk of aspiration, as the improper movement of the bolus through the pharynx and around the larynx increases the risk.
The early detection and proper management of dysphagia, including adequate nutritional management and successful swallowing rehabilitation, may help prevent malnutrition and pneumonia in stroke patients.
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Aspiration pneumonia is caused by inhaling mouth secretions, stomach contents, or both
Aspiration pneumonia is a lung infection caused by inhaling oral or gastric contents. It is a complication of pulmonary aspiration, which is when you inhale food, stomach acid, or saliva into your lungs.
Aspiration pneumonia is caused by breathing in something that results in infection, swollen bronchioles, and fluid-filled air spaces that make breathing difficult. The substance brings in bacteria, which can cause the infection. The underlying cause of any case of aspiration pneumonia is breathing or sucking in a foreign substance, like food, drink, medication, or others, into the lungs. The substance causes bacterial growth, leading to a non-contagious infection.
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Aspiration pneumonia can be prevented by improving swallowing abilities
Aspiration pneumonia is a type of lung infection that occurs when a person breathes something into their lungs instead of swallowing it. This can include food, saliva, vomit, or medication.
Aspiration pneumonia is more common in people with existing health complications, such as swallowing disorders, neurological disorders, or a weakened immune system.
- Practicing good dental and oral hygiene
- Sitting up while eating and chewing slowly and deliberately
- Avoiding laughing or talking while eating
- Seeking counseling for alcohol or substance misuse
- Avoiding foods that are difficult to swallow
- Adjusting the dosage or switching medications that affect swallowing
- Receiving a swallowing evaluation by a licensed speech pathologist or swallow therapist
- Implementing postural changes that improve swallowing, such as a chin-down posture for patients with a tongue base swallowing disorder
SARS-CoV-2, the virus that causes COVID-19, can damage the heart and increase the risk of stroke, even without directly infecting the heart tissue. This is due to the body's immune response to the virus, which can trigger inflammation throughout the body.
Infection with SARS-CoV-2 has been associated with an increased risk of stroke, particularly in young patients without classic vascular risk factors. This may be due to the virus's ability to invade the central nervous system through various routes, including neuronal and hematogenous transmission.
In addition, critical illness and prolonged hospitalization associated with COVID-19 can increase the risk of stroke. Factors such as immobility, catheter use, temperature instability, and insufficient oral intake can contribute to this increased risk.
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A speech-language pathologist can help patients improve their dysphagia
A stroke can cause dysphagia, or difficulty swallowing, in patients. This can lead to aspiration pneumonia, a lung infection caused by inhaling mouth secretions, stomach contents, or both. Dysphagia can also lead to aspiration pneumonitis, which is caused by inhaling toxic substances such as stomach acid, mineral oils, or kerosene.
Speech-language pathologists (SLPs) are trained professionals who can help patients with dysphagia. They evaluate a patient's swallowing ability and develop an individualized treatment plan to help patients regain their swallowing skills. The evaluation includes an assessment of oral muscle movement, cognitive function, and larynx function. The treatment plan may include exercises to improve muscle coordination, techniques to compensate for lost function, and dietary modifications such as thickened liquids and pureed foods.
SLPs can also conduct more advanced tests, such as a modified barium swallow study (MBSS) or a fiberoptic endoscopic evaluation of swallowing (FEES), to assess the function of the swallowing mechanism and determine the best course of treatment. These tests can accurately assess penetration or aspiration of food and liquids into the lungs.
Through therapy and exercises, SLPs can help patients improve their swallowing function and coordination, reducing the risk of aspiration and associated complications such as aspiration pneumonia.
In summary, speech-language pathologists play a crucial role in the management of dysphagia in patients who have experienced a stroke. By evaluating, diagnosing, and providing rehabilitation services, SLPs can help improve swallowing function, reduce the risk of aspiration, and enhance the overall quality of life for these patients.
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Frequently asked questions
Lung infection, specifically pneumonia, is a common complication after a stroke. Pneumonia can be caused by inhaling foreign substances, such as food or liquid, which can lead to an infection in the lungs. This is known as aspiration pneumonia.
Signs of pneumonia after a stroke can include chest pain, shortness of breath, blue discolouration of the skin, coughing up blood, and fatigue, especially while eating. However, many stroke patients experience "silent aspiration", where they inhale food or liquid without coughing or feeling it.
Pneumonia is usually diagnosed through a physical exam, where doctors look for signs such as decreased airflow and abnormal sounds in the lungs. They may also order specialised tests, such as a chest X-ray, arterial blood gas test, or sputum culture. Treatment for pneumonia typically involves a course of antibiotics, and more severe cases may require hospitalisation, supplemental oxygen, and steroids.
The best way to prevent pneumonia after a stroke is to treat dysphagia, or difficulty swallowing, which is often the root cause of pneumonia in stroke patients. Working with a speech therapist, electrical stimulation, and Botox injections can help improve swallowing abilities and reduce aspiration. Additionally, compensation techniques, such as sitting up straight, eating slowly, and avoiding complex foods, can help reduce the risk of aspiration and pneumonia.
Pneumonia after a stroke can be a serious, life-threatening condition. It can slow down a survivor's recovery and, in severe cases, may require the use of a ventilator to breathe.
