Chronic lung disease and aspiration in people with cerebral palsy

Some people with severe cerebral palsy develop chronic lung disease due to recurrent aspiration and associated inflammation and infection. The risk of aspiration relates to oromotor dysfunction (see Dysphagia in people with developmental disability). Having an inefficient cough and kyphoscoliosis may also contribute to chronic lung disease. ‘Red flags’ for aspiration include coughing or choking when eating or drinking, and recurrent wheezing episodes or chest infections, but aspiration may also be silent.

Regular screening for oromotor dysfunction is recommended. Ask about swallowing, coughing or choking during mealtimes, or wheeze during or after meals; see also Clinical presentation of dysphagia in a person with developmental disability. Specific questions about oromotor function should be included in the patient’s annual health assessment. Advise carers to report to the doctor if they notice the indicators of aspiration in a person with cerebral palsy.

Preventive health care (ie immunisation) is essential to reduce the risk of respiratory disorders. It is important to distinguish aspiration pneumonia from aspiration events and aspiration pneumonitis because antibiotic therapy is only needed for aspiration pneumonia. Definitions of aspiration-related terms defines aspiration-related terms and explains the role of antibiotic therapy.

If swallowing problems or aspiration are suspected, refer people with cerebral palsy to a speech pathologist for a comprehensive swallowing assessment. In the presence of a diagnosed swallowing issue, a speech pathologist and a dietitian can provide swallowing strategies and a modified diet to reduce the risk of aspiration and provide optimal nutrition.