Microaspirations

I hit the other rehab with renewed vigor yesterday. After telling the RNs who were there for a cardiac rehab class about the downturn with my lungs, they strongly suggested that I use a mask while at their gym. One said that I cannot afford anymore lung capacity lost due to a cold or the flu. It could kill me. She is right. So, I will be wearing a mask along with my oxygen while working out.

Something I forgot to blog yesterday that Dr. K. talked about during the appointment on Monday was microaspirations. Non-acid microaspirations. Here is some background information I pulled from the Internet:        http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2851633/

Aspiration is defined as the inhalation of oropharyngeal or gastric contents into the larynx and lower respiratory tract.⁶ The clinical syndrome due to aspiration (e.g. aspiration pneumonitis, aspiration pneumonia) depends on the nature and volume of aspirated material, the frequency of aspiration, and the host’s response to the aspirated material.

The term “silent” microaspiration is used when patients have asymptomatic aspiration of small volumes of oropharyngeal secretions or gastric fluid into their lungs. Approximately half of all healthy adults aspirate small amounts of oropharyngeal secretions during sleep⁷ and other co-morbidities may increase the risk of aspiration (e.g. scleroderma, cerebrovascular disease, and degenerative neurologic disease).^6, 8, 9However, normal host defenses (e.g. glottis closure, cough reflex) are usually able to compensate.¹⁰Depending on the frequency and intensity of the silent microaspiration, and, perhaps, genetic predisposition, patients may manifest with cough, wheeze, or mild gas exchange abnormalities.¹¹

Gastroesophageal reflux and silent microaspiration is associated with several lung diseases and among those who have had lung transplantation.^12, 13 Lipoid pneumonia is caused by the silent microaspiration of exogenous lipid (usually a complication of long-term ingestion of oil-based compounds) that leads to a chronic inflammatory pneumonitis that often progresses to fibrosis.¹⁰ Silent microaspiration has also been suggested as a cause of chronic bronchiolar and interstitial lung disease.¹⁴ Lastly, data from the lung transplantation literature strongly suggests that chronic silent microaspiration is associated with post-transplantation bronchiolitis obliterans, the primary lesion in chronic organ rejection.¹⁵ In fact, several studies have suggested that early fundoplication improves survival and decreases chronic allograft rejection in this population, presumably through reducing the frequency of silent microaspiration.

Stuff coming up from the gut into the lungs causing problems with the lungs. I have had the fundoplication surgery, but she said that often the microaspirations still get through. I sleep on a wedge yet I have noticed that I had been burping a lot recently - it has since slowed down - so maybe she is right, once again. She told me to remember to stand straight, do not lean forward to eat or to garden or while driving. It apparently helps to stay totally upright so ballet posture!