Aspiration Lung Injury

Aspiration, defined as the entrance of foreign material into the airway, is relatively common, but when it occurs frequently, recurrently, or in large amounts, there can be significant lung impact resulting in clinical signs and symptoms and permanent damage to the lungs [1, 2]. Most literature focuses on large volume aspiration resulting in aspiration pneumonitis and aspiration pneumonia. However, pediatric aspiration due to dysphagia is more commonly chronic microaspiration, referred to as Chronic Pulmonary Aspiration (CPA) [2, 3]. The amount, either in terms of volume or duration, of CPA that results in symptoms and ultimately permanent lung damage is unknown. Therefore, interventions and therapies are recommended to patients and families based upon the best judgment and experience of the clinical team and are generally guided by the child’s clinical symptoms and diagnostic studies. Many questions remain unanswered in the literature. In this chapter, we aim to review the pathophysiology of CPA, presenting symptoms of CPA, the differential diagnosis of these symptoms, and the recommended evaluation and management. Finally, we comment upon the important unanswered questions and areas for future research.