Understanding dysphagia and aspiration

Aspiration is when something enters the airway or lungs by accident. It may be food, liquid, or some other material. This can cause serious health problems, such as pneumonia. When a person has dysphagia, aspiration is always a risk. You may be at risk for aspiration from dysphagia if you have any of these health conditions:

• Stroke

• Severe dental problems

• Conditions that lead to less saliva, such as Sjögren syndrome

• Mouth sores     

• Parkinson disease or other nervous system conditions

• Muscular dystrophies

• Blockage in the esophagus, such as a growth from cancer

• History of radiation or surgery for throat cancer

• Dementia, memory loss, or cognitive decline

A person with dysphagia may aspirate thin liquids more easily. Because of this, some people with dysphagia need to not have certain liquids. Or liquids need to be made thicker.

Liquids come in different types. Some are thin and flow quickly. Others are thicker and flow more slowly. Thicker liquids that flow slowly are easier to swallow. The liquids that may work best depend on how serious your dysphagia is. Drinking the right types of liquids will help reduce your risk for aspiration.

Levels of liquids in a dysphagia diet

The International Dysphagia Diet Standardization Initiative has created a diet plan for people with dysphagia. The dysphagia diet has levels that rate drinks and foods on a thickness scale from 0 to 7. Drinks are ranked from 0 to 4 on this scale:

• Level 0 (thin). These are watery liquids, such as juice, tea, milk, soda, beer, and broth. You can drink them through a nipple, cup, or straw.

• Level 1 (slightly thick). These are thicker than water. They need more effort to drink than thinner liquids but still flow through a straw or nipple.

• Level 2 (mildly thick). These liquids flow off a spoon but more slowly than thinner drinks. They can be sipped or sucked from a straw with some effort.

• Level 3 (liquidized, moderately thick). You can drink these from a cup or sucked from a straw with some effort. These are liquids that may be thick enough to be eaten with a spoon. An example is a thick milkshake. Their texture is smooth without lumps.

• Level 4 (pureed, extremely thick). These are usually eaten with a spoon. You can't drink them from a cup. An example is pudding.

Ways to manage your liquids

You can manage your liquids by making thin liquids thicker. This is done by adding a flavorless gel, gum, powder, or another liquid to it. These are called thickeners. By adding a thickener, you can bring any liquid to the right level of thickness that you need. You may be able to buy thickeners at a pharmacy. Or you may buy them in medical supply stores. Thickeners have directions on the package that show how to use them. You can also buy prethickened liquids. These may be more expensive, but you don't need to prepare them first. Talk with your SLP if you have any questions about preparing your liquids.

Many people don't enjoy drinking liquids with added thickeners. These thickeners may lessen flavor, make you feel full quickly, or form lumps. Some people prefer the taste of one thickener over another. Other people may prefer premade products. Try different types to find the thickened liquids that you most enjoy.

When it’s time to drink

While drinking, it may help to sit upright. You may need support pillows to get into the best position. It may also help to have few distractions while drinking. Changing between solid food and liquids may also help your swallowing. Stay upright for at least 30 minutes after eating. This can help reduce the risk for aspiration.

Keep watch for symptoms of aspiration, such as:

• Coughing or wheezing during or right after eating

• Too much saliva

• Shortness of breath or tiredness while eating

• A wet-sounding voice during or after eating or drinking

• Fever 30 to 60 minutes after eating

While you’re on a dysphagia diet

While on a dysphagia diet, you may have trouble getting enough fluid. This can cause dehydration, which can lead to serious health problems. Talk with your healthcare team about how you can help prevent this. In some cases, drinking thicker liquids may make some of your medicines work less well. Because of this, you may need some of your medicines changed for a while.

Many people with dysphagia also need to be careful about the foods they eat. Talk with your SLP about the foods that are allowed on your dysphagia diet.

Also make sure to:

• Follow all directions about what food and drink you can have.

• Do swallowing exercises as advised.

• Don't change your food or liquids, even if your swallowing gets better. Talk with your healthcare provider first.

• Tell all healthcare providers and caregivers that you are on a dysphagia diet. Explain which foods and liquids you can and can’t have.

Follow-up testing

Your healthcare team will keep track of how well you are swallowing. You may need follow-up tests, such as a fiberoptic endoscopic evaluation of swallowing test or a modified barium swallow study. If your swallowing gets better, you may be able to drink thinner liquids over time. In time, you may be able to drink liquids of all kinds. If your swallowing gets worse, you may need to drink only thicker liquids for a time.

When to call your healthcare provider

Call your healthcare provider right away if any of the following occur:

• Your trouble swallowing gets worse

• Symptoms of dehydration

• Shortness of breath or tiredness while eating

• A wet-sounding voice after eating or drinking

• Fevers or coughing while eating