Hyperinflated lungs from aspiration pneumonia or low O2?

[bwell2day]

Is it possible that aspiration pneumonia (oatmeal lodged in the trachea) can exacerbate COPD and/or asthma, thus causing the mild hyperinflation on an x-ray?  The 70-yr-old patient is a former smoker (most of her life) and was found w/ an O2 sat of 40% that was a result of the bolus of food that the paramedics had to "force" a breathing tube through.  Keep in mind, neither the amount of time that the oatmeal was lodged, nor the amount of time the O2 was low, cannot be verified.  It could've been mins, hrs, or up to a day and a half.

Could the low O2 (sustained for min, hrs, or over a day) cause the hyperinflation or contribute to it?  The timing of events cannot be verified AT ALL.

And what if the patient has never smoked?

Thanks for your time.

[bwell2day]

Thanks so much for your response and your time.

I was just curious if a non-smoker could also have hyper inflated lungs.

The patient, who had had surgery on a broken hip 4 days before the O2 was found to be low, developed one clot in the opposite leg later that night (surgery was successful), and developed a clot in the leg of the broken hip the next day. She died of cardiac arrest and kidney failure less than two days after the low O2 was discovered.  It was all very fast.

They are saying the cause of death is cardiac arrest and that the conditions leading up to it are: aspiration pneumonia, COPD, and Peripheral Vascular Disease.

She had a history of moderate hypertension and high cholesterol, but not PVD.  She was an alcoholic as well.  She was admitted to the ER with a coma scale of 4 and sepsis, which could have easily caused the clots.

So I'm having a hard time understanding how COPD and PVD are two of the three contributing factors, rather than sepsis or metabolic encephalopathy (which were also mentioned in her records)

Wouldn't COPD and PVD infer that she had pre-existing conditions that led to her death?

Thanks again.

[David Tinkelman, M.D.]

Yes, aspiration of practically any substance can result in “mild hyperinflation”, not infrequently localized hyperinflation.  Should the person have underlying asthma or COPD, the answer is also yes; either condition could worsen, at least transiently, following aspiration.  

But note, the observation of hyperinflation is the least important aspect of the situation you describe.   The most important is the reduced oxygen concentration, the severity  and duration and persistence of it.  40% is very low and the most important issues right now are:   1) to make sure that this person’s oxygen saturation is now being maintained at a greater than 90% level at all times, night and day and 2) close follow-up to make sure that chronic pneumonia or abscess has not developed at the site of aspiration, within her lungs.  

You ask, “what if the patient has never smoked” but previously stated that she is “a former smoker (most of her life)”.  If the patient has underlying COPD and the aspirated material is still in her lungs, that could seriously further compromise her lung function.

I strongly recommend that you and her doctor seek a second opinion from a lung specialist, ideally one familiar with the natural history of aspiration.

Finally, the question of her having a swallowing disorder should also be investigated.

Good luck