Why Aspiration Is an Invisible Danger in Cystic Fibrosis

Recent research shows that aspiration is a silent and hidden danger for patients with cystic fibrosis. Aspiration refers to breathing in foreign objects, such as food or saliva, into the airways.
It is quite common in older individuals, as it is typically a result of having troubling swallowing. Very often aspiration will not cause any symptoms; however, it can cause sudden coughing, wheezing, or having trouble breathing while trying to dispose of the foreign object(s).

Aspiration defined

“Aspiration is defined as any liquid, substance, or foreign body that gains access (below the vocal cords) to the airways. Many times when we have an overt aspiration, a cough is triggered. Think, ‘something went down the wrong pipe.’ This may occur when folks drink fluids too quickly, toss their head back to take pills, etc. A small amount of liquid trickles down the windpipe, irritating it and causing a cough. Additionally, overt aspiration may occur in some folks with neurologic disorders that impair the ability to swallow appropriately (think stroke, Parkinson’s disease, etc.). Silent aspiration may also occur in many neuromuscular disorders as well in ‘normal’ hosts. This is where my patient population lives for the most part. There are two distinct situations that may occur. The first would be that when we take a drink, some small amounts of liquid ‘pools’ in a recess around the vocal cords and then little amounts can trickle over the vocal cords down into the airway, but it does not trigger a cough or any sensation that something has just gained access to the airway. The second scenario is when we silently or overtly reflux up liquids from the stomach or esophagus and they reach high enough in the esophagus that they then trickle into the airway,” said Dr. Gwen A. Huitt, an infectious disease doctor at National Jewish Health.

The dangers of aspiration for cystic fibrosis patients

Dr. Huitt feels that aspiration does not receive enough attention among the CF community. When asked what is most likely to trigger the onset of aspiration, she said – “For our patient population, we believe that over-distending the stomach with too much liquid, bending forward or lying too flat on your back, stomach, or on your right side contributes to most of our silent reflux episodes.”
When asked about the dangers of aspiration to patients with cystic fibrosis, she stressed – “The dangers of aspiration for CF or non-CF patients are that you are sending not only germs such as pseudomonas or non-tuberculosis mycobacteria (NTM) into the airway that contribute to infection, but also that digestive enzymes and acids cause significant inflammation in the airways. This situation worsens inflammation and infection in the vulnerable airway.

A recent research study

In a recent study that involved the participation of 33 adult patients with cystic fibrosis, each patient underwent monitoring to undercover signs of acidity, weakly acid gastro-oesophageal reflux (GOR), and aspiration. Coughs, saliva and bronchoalveolar lavage fluid (BALF) were recorded and tested for bile acids. 

Read on to learn about the results of this study and what this means for people with cystic fibrosis.