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EDs meet criteria for persistent chronic asthma severity, yet prescriptions are not
provided or patients are noncompliant with therapy. Therefore, the ED visit for
asthma represents an opportunity to improve outcomes for these children.

ASPIRATION PNEUMONIA
CLINICAL PEARLS AND PITFALLS
Aspiration pneumonitis refers to chemical injury and inflammation of
lung tissue after inhalation of foreign material, whereas aspiration
pneumonia refers to infection of lung tissue following pneumonitis.
Patients at risk for aspiration pneumonia include those with impaired
neurologic status, technology dependence, oropharyngeal dysfunction,
and gastrointestinal dysmotility.
Initial chest radiographs may be normal following aspiration episodes.
Treatment with antibiotics is generally reserved for patients with
significant respiratory impairment and signs of infection or complicating
medical history.
Treatment with corticosteroids is not routinely indicated.

Current Evidence
Aspiration of foreign material into the lung can result in inflammation and
impaired lung function. Aspiration pneumonitis (also referred to as chemical
pneumonitis) refers to chemical injury and inflammation of lung tissue from
inhaled foreign material, with sterile acidic gastric contents being the most
common source. Aspiration pneumonia refers to infection of lung tissue
following inhalation of foreign material, often due to bacteria from the
oropharynx.
The pathophysiology of pulmonary disease following aspiration has been
studied in animal models. These studies have demonstrated that a relatively large
volume acidic inoculum will induce pathologic changes within minutes including
atelectasis, peribronchial hemorrhage, and pulmonary edema. There is an
appreciable inflammatory response on pathology with polymorphonuclear cells

and fibrin along with hyaline membrane deposits. These responses are mediated
through multiple proinflammatory cytokines.
Aspiration of hydrocarbons is covered separately in Chapter 102 Toxicologic
Emergencies .