From the Research
Recurrent aspiration pneumonia in patients with anorexia nervosa requires a comprehensive approach addressing both conditions simultaneously, with a focus on nutritional rehabilitation and aspiration prevention strategies. Treatment should focus on managing the current pneumonia with appropriate antibiotics, such as azithromycin, which has been shown to be effective in aspiration pneumonia 1.
Key Considerations
- Nutritional rehabilitation is essential and should begin with small, frequent meals, gradually increasing caloric intake by 200-300 calories every 2-3 days until reaching appropriate levels.
- A multidisciplinary team including a pulmonologist, psychiatrist, and nutritionist is crucial for effective management.
- For aspiration prevention, patients should eat in an upright position, remain upright for 30 minutes after meals, and consume thickened liquids if swallowing difficulties are present.
- Addressing the underlying eating disorder through cognitive-behavioral therapy, possibly combined with medications like fluoxetine (20-60 mg daily) for anorexia nervosa, is necessary for long-term resolution of recurrent aspiration pneumonia.
Aspiration Prevention Strategies
- Patients with severe anorexia nervosa should be screened for possible dysphagia, as oropharyngeal dysphagia can occur in these patients, placing them at risk for aspiration and impeding nutritional rehabilitation 2.
- The use of neuromuscular electrical stimulation (NMES) in conjunction with swallowing therapy may be beneficial in reducing the need for enteral feeds and prolonged hospitalization 2.
Nutritional Management
- Prescribing recommended doses of parenteral nutrition, including energy, amino acids, and fat, may be beneficial when managing parenteral nutrition of patients during nil per os (NPO) periods 3.
- Commonly prescribed parenteral nutrition solutions, such as carbohydrate/electrolyte solutions and peripheral parenteral nutrition solutions, should be used judiciously, with consideration of the patient's individual nutritional needs 3.