Update on the pathogenesis and management of pneumonia in the elderly-roles of aspiration pneumonia.
Pneumonia in the elderly results in the highest mortality among cases of community-acquired pneumonia (CAP). The pathophysiology of pneumonia in the elderly is primarily due to aspiration pneumonia (ASP). ASP comprises two pathological conditions: airspace infiltration with bacterial pathogens and dysphagia-associated miss-swallowing. The first-line therapy for the treatment of bacterial pneumonia in the elderly is a narrow spectrum of antibiotics, including sulbactam/ampicillin, which are effective against major lower respiratory infection pathogens and anaerobes. The bacterial pathogens of ASP cases of pneumonia in the elderly are similar to those associated with adult CAP. In addition to an appropriate course of antibiotics, pharmacologic and non-pharmacologic approaches for dysphagia and upper airway management are necessary for the treatment and prevention of pneumonia. Swallowing rehabilitation, oral health care, pneumococcal vaccination, gastroesophageal reflux management, and a head-up position during the night are necessary for the treatment and prevention of repeated episodes of pneumonia in elderly patients. In addition, tuberculosis should always be considered for the differential diagnosis of pneumonia in this patient population.
Department of Pulmonary Medicine, Hitachinaka Medical Education and Research Center, University of Tsukuba, 20-1 Hitachinaka-shi, Ibaraki 329-8575, Japan. Electronic address: shinjit-tky@umin.ac.jp.
Shinji
S
Teramoto
Department of Pulmonary Medicine, Hitachinaka General Hospital, Hitachi Ltd., Ibaraki, Japan.
Kazufumi
K
Yoshida
Department of Pulmonary Medicine, Graduate School of Comprehensive Human Science, University of Tsukuba, Ibaraki, Japan.
Nobuyuki
N
Hizawa
D058109:Airway Management; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003679:Deglutition; D003680:Deglutition Disorders / Q000150:complications / Q000503:physiopathology / Q000534:rehabilitation; D003937:Diagnosis, Differential; D005764:Gastroesophageal Reflux / Q000150:complications / Q000628:therapy; D006801:Humans; D008297:Male; D022242:Pneumococcal Vaccines; D011187:Posture; D012008:Recurrence; D012141:Respiratory Tract Infections / Q000150:complications / Q000382:microbiology
D000900:Anti-Bacterial Agents; D022242:Pneumococcal Vaccines
Aspiration pneumonia; Dysphagia; Oral health care; Pneumococcal vaccination; Swallowing rehabilitation