BTS Clinical StatementBTS clinical statement on aspiration pneumoniaA John Simpson,12 Jamie-Leigh Allen,3 Michelle Chatwin,.5 Hannah Crawford,67.8Joanna Elverson,2 Victoria Ewan,Julian Forton,1112 Ronan McMullan,1314John Plevris,56 Kate Renton,3.17 Hilary Tedd,2 Rhys Thomas,Julian Legg3BACKGROUND.DEFINITIONS.AIMS AND SCOPEdifficulties are used instead of the term dysphagia,OF THE CLINICAL STATEMENTthroughout.This BTS Clinical Statement seeks to provide prac-AP is a common condition predominantlytical clinical guidance on aspiration pneumoniaaffecting older patients,and as the world's popula-Additional supplemental(AP),through sections covering the relevant epide-tion continues to expand and age,AP will becomematerial is published onlinemiology,pathogenesis,prevention,diagnosis andan increasing concern for healthcare systems glob-only.To view,please visit themanagement (including palliative care consider-ally.Impaired swallowing can lead to malnutrition,joumal online (http://dx.doiations where appropriate).Key clinical practicedehydration,choking,reduced quality of life and0rg/10.1136/thorax-2022-219699).points appear at the end of each of these sectionsdeath.7 Because so many people are at risk ofand are brought together in the highlighteddeveloping AB a significant emphasis of this State-For numbered affiliations seesummary below.Areas requiring important researchment is on prevention.end of article.to fill key knowledge gaps are highlighted in a sepa-AP has been the subject of excellent reviews andrate section.commentaries.s-13 However,two broad factorsCorrespondence toProf A John Simpson,MedicalThe Statement arose because AP is dispropor-make it harder to generalise findings across studiesSchool Newcastle University.tionately represented in people with a learningon AP First,it is often hard to diagnose AP withNewcastle upon Tyne,UK;disability,in whom it is a major cause of death.certainty,as microaspiration may be clinically.simpson@newcastle.ac.ukThe management of patients with community-'silent'and unwitnessed.Second,microaspirationacquired pneumonia(CAP)and learning disabilitydue to abnormal swallowing results from a wideis,therefore,the focus of a comprehensive parallelrange of pathologies,and so heterogeneous patientBTS Clinical Statement,in which learning disabilitygroups are included in published studies on Apis carefully defined.2Despite this,however,mostThe Statement focuses on the common clin-AP still occurs in people who do not have a learningical setting in which bacteria-rich oropharyngealdisability.The existing literature on AP is of insuf-secretions are microaspirated into the lung.Theficient depth and quality to construct formal,following are not considered here:aspirationcomprehensive guidelines.For these reasons,thepneumonitis/"gross aspiration"(in which a largeBTS proposed a Clinical Statement devoted to APvolume of vomitus of low pH suddenly enters theas a stand-alone document,but which specificallylungs,initially causing a
