A serious and often overlooked issue for patients with brain diseases: Swallowing

recall that final time you had something “ go down the wrong pipe ” ? You spent the adjacent several minutes coughing, choking and feeling like something bad was in your throat .
It may seem strange to say this, but count yourself lucky .
Your brain was making you do the right things to keep what you drank or ate out of your lungs. The path for vent to enter our lungs, the larynx ( or articulation box ), is very close to the upper esophageal sphincter, the entrance point for food and liquids to our esophagus. This close anatomic relationship of these two entrance points means the brain must coordinate breathe, eat and drink to ensure the lungs get only air out and the esophagus gets only food or liquids. This coordination happens unconsciously, so we never actually think about it until we get food or melted in our airline .
As it turns out, millions of people with brain diseases, including those with Alzheimer ’ mho, Parkinson ’ s, Lou Gehrig ’ second disease, stroke, multiple sclerosis and traumatic brain injury, have impaired swallow. As a leave, they are unable to protect their lungs in the means that a healthy person can.

The solution is that millions of mind disease patients are at risk for inhaling food and saliva into the lungs, leading to death by pneumonia or even choking .
Detecting and treating impair swallow is significant, particularly as the nation ’ s closely 70 million baby boomers continue to age. Impaired swallow is associated with many conditions of the aged, and it is much badly underreported. Clinicians may not detect it or may see it as a side consequence of another condition .
As a neuroscientist who has studied brain diseases, I know of no pharmaceutical companies that have drug discovery programs aimed at restoring weakened swallow and cough. And yet, it ’ s a major trouble .

Hard to swallow, easy to choke

An important part of swallow is complete blockage of the larynx while food is moving through the throat. Disordered swallow, or dysphagia, limits the ability of the muscles in the mouth and throat to move melted or food into and through the esophagus and on to the stomach .
This inability to protect the airways and lungs increases the hazard of pneumonia or choke .
In addition, many people with brain disorders experience reduced cough, or a hurt ability to activate breathing muscles to generate airflows that eject fabric from the lungs. Weakened cough is caused by problems with nerves in our lungs that detect foreign substantial or with the brain driving the respiratory muscles .
Disordered swallow can besides be caused by problems with nerves in the neck. For case, people who have had cancer of the head or neck frequently undergo extensive operation to remove the diseased weave. This work can unwittingly damage nerves that are significant for swallowing .
sometimes, the swallow damage, quite than the primary mind disease, actually leads to death. When swallowing is impaired, it is more probable that material will enter the lungs and trachea during feed or drink. This is known as inhalation. Aspirated food or drink “ seeds ” the lungs with material that is coated with pathogens from the talk. These pathogens are not normally present in the lungs and can cause chronic excitement and serious bouts of pneumonia.

When a weak cough is a bad sign

In patients with acuate stroke, austere swallow and cough impairments occur at the lapp time. Our research has shown that the risk of inhalation due to swallow damage can be predicted by diminished cough in patients with stroke or Parkinson ’ randomness disease. These findings indicate that brain diseases can lead to multiple impairments in how we protect our airways .
Another way of thinking about this problem is that the aflutter system has many tools, or reflexes, that it uses to perform certain tasks. Each reflex has a specific function, and the brain coordinates the time of occurrence of each to optimize the leave .
For example, a cough can eject material out of the airways into the throat and out of the mouth. Swallows frequently occur barely after coughs to move material that was deposited into the throat into the esophagus and then the stomach. The consequence is that lungs were cleared by coughing, and swallowing moved any remaining material out of the throat to prevent ambition .

Nearly half of residents of long-term care facilities vulnerable to pneumonia

coincident impairments of cough and swallow star to high aspiration risk. This high hazard is ascribable to seeding of the lower airways with harmful pathogens that increase the risk of pneumonia. Mortality rates of inhalation pneumonia have been reported of over 60 percentage, leading to a US $ 4.4 billion medical burden from hospitalized patients alone in 1997. Aspiration pneumonia costs arsenic much as $ 17,000 per hospital admission. far, this type of pneumonia can occur in angstrom many as half of long-run concern residents .
When members of our research team talk to their friends about respiratory tract protective covering and its consequences, everyone seems to have a history. Most center around an older proportional who had a mind disorder and the difficulties this person had eat. Often their relative choked when eating or had to eat special thick foods. These are signs of afflicted swallow, cough and ambition .
speech pathologists specialize in diagnosing and treating swallowing disorders. They much recommend dense foods that are easier to swallow and less probable to penetrate the airways during swallowing. This clinical set about is the most well-accepted .
Some companies market devices that apply a weak electrical current to the neck to improve swallow. The long-run profit of these devices is controversial. Further, these therapies have not been shown to enhance a de-escalate cough automatic .
There are no drugs for the discussion of impair swallow or cough. It appears that the pharmaceutical diligence has not yet recognized the importance of prevention of aspiration in patients with neurological disease in disease consequence.

A team in Japan has promoted a comprehensive protocol using centripetal stimuli such as menthol and capsaicin, the pungent component in loss peppers, to help aged people who have serious impairments in swallowing. Their preliminary results show impressive improvements in reducing inhalation pneumonia in these patients .
There is a promising approach based on strengthening breathing muscles that has been shown to improve swallow and cough function in patients with Parkinson ’ sulfur disease and stroke. This access is called “ expiratory brawn persuasiveness discipline, ” and it is easy for health worry professionals and most patients to perform. The extent to which this method can prevent pneumonia in at-risk patients is unknown at this meter .
In short, while there are some promise approaches, there are no widely accepted therapies for restoring weakened swallow and cough in patients at significant risk of aspiration. Continued research on the fundamental neurological mechanisms of coughing and swallowing will provide a foundation for new therapies to reduce the occurrence and severity of inhalation pneumonia .

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