A swallowing problem which includes aspiration is a fear of many individuals with a neurodegenerative disease diagnosis such as Parkinson’s Disease (PD) or related disorders such as PSP or MSA. (pulmonary aspiration is defined as the entry of material (saliva, food or drink, or stomach contents from reflux, entering into the trachea and lower airways, and sometimes resulting in aspiration pneumonia.)

At one time or another, we all have episodes of aspiration, sometimes during sleep or when laughing or speaking while eating and drinking. We usually say something “went down the wrong pipe.” These occasional episodes are usually of minor consequence to healthy lungs, and a vigorous cough is our signal that something went wrong. Cough is also our body’s reflexive and protective response to something threatening the airway.

So, why such a fuss when a video-flouroscopic swallow study, (VFSS/MBS) shows that an individual has aspirated? Does any one documented episode of aspiration call for a change in the consistency of liquids and solids consumed?

These questions have no “one size fits all” type of answer. How any one individual will respond to one or multiple episodes of aspiration will have much to do with their own constitution as well as any other recent surgeries or medical problems. In the case of Parkinson’s disease and related disorders, some subtle changes in the respiratory-deglutative (swallowing) mechanisms are probably going on for a number of years before they are even noticed. Just as PD affects skeletal muscles in the arms and legs causing them to become stiff and less coordinated, the muscles involved with breathing and swallowing are also undergoing changes, but symptoms may be subtle.

Aspiration Pneumonia – The Perfect Storm

 So why do some people develop aspiration pneumonia and what can prevent it?  Aspiration pneumonia is considered an opportunistic infection, and a perfect storm of factors mentioned below can often contribute to how well any one individual will be able to defend against the development of a pneumonia or succumb to it. Dysphagia ( a swallowing problem) may be a risk factor, but does not seem to be sufficient alone to lead to aspiration pneumonia and so typically other factors must be present. Some studies indicate that patients with deconditioning and generalized dysphagia due to frailty and dementia have substantially increased risk of pneumonia and overall mortality.[i]

Like a tropical depression developing in the Atlantic, the right conditions need to be in place for the development of a “perfect storm,” and in the case of aspiration pneumonia, conditions include:

• A serious illness or recent surgery
• Weakened or deconditioned muscles from disease or disuse as when recovering from a surgery
• Poor oral hygiene ( not brushing teeth or dentures) and bacteria from the mouth travels on secretions into the airway
• Poor cough effort reducing the ability to clear material from the upper and lower airways
• Long periods of being bed bound and unable to feed or move one’s self
• The material aspirated can also be a factor, with water  aspirated in trace amounts being less harmful to the lungs than food particles

Building a Defense Mechanism

So, what can someone with Parkinson’s and related disease diagnosis do to prepare their body for an impending “storm”.

• Strengthen and fortify muscles, including throat muscles with exercise.
• Performed respiratory strengthening exercise/s to improve cough power or strength, and to mobilize pulmonary secretions.
• If hospitalized, work with nursing, physical therapy, and speech therapy soon after surgery to regain muscle strength and cough power.
• Brush teeth or dentures daily and after meals

Your speech-language pathologist/swallowing therapist may provide you with specific exercises or swallowing techniques specific to problems you may already have been identified as having, or they may recommend exercise/s intended to reduce your risk of developing aspiration pneumonia. Adhering to  recommendations  is important, and may be your best defense against developing a more serious illness or help you  recover if you have already diagnosed with aspiration pneumonia

Video swallow image of a 67 yo patient with Parkinson’s disease. The patient is active and in good health, but did not feel the piece of chicken which was stuck at the base of his tongue.      What is his aspiration risk?

In Summary

An acute illness or surgery, a fall resulting in a hospitalization, a disruption in medication schedules, reduced mobility, and weakened cough, are all factors that can increase the likelihood of  an inconsequential or occasional episode of aspiration turning into an aspiration pneumonia. If you have never undergone a swallowing evaluation, and you have a diagnosis of Parkinson’s or related disease diagnosis, discuss a referral to a speech-language pathologist on your next office visit to your neurologist.

[i] Evaluation of the Natural History of Patients Who AspirateJonathan M. Bock, MD, FACS*, Varun Varadarajan, MD, Mary C. Brawley, CCC-SLP, and Joel H. Blumin, MD, FACS  Laryngoscope. 2017 December ; 127(Suppl 8): S1–S10. doi:10.1002/lary.26854.

Hi-VOLT® 4 PD voice-activated bracelet

Hi-VOLT® 4 PD a calibrated feedback tool was featured in the Hope Parkinson Program newsletter. Read or download their current newsletter: https://drive.google.com/file/d/10_nOvgFZaoHoKx2OMCu0QPSk2lWwXkT8/view

Upcoming Symposium

2019 Parkinson’s disease Awareness Month Symposium presented by Parkinson’s Disease Treatment Center of SWFL

Free seminar includes Guest Speakers: John Morgan, MD,PhD, Director of Movement and Memory Disorders Program Medical College of Georgia; Mabel Lopez, PhD, Neuropsychologist and Director of “Mind and Brain Care,” located in Fort Myers, Fl, and Ramon Gil, MD, Medical Director, Parkinson’s Disease Treatment Center of SW FL

To register or for additional information contact Jennifer at: 941-743-4987 or email: office@parkinsonsfl.com