Interventions to prevent pneumonia among older adults

口咽细菌病原体吸入下呼吸道是肺炎最重要的危险因素之一；老年人的吞咽和咳嗽反射障碍，例如与脑血管疾病有关的障碍，增加了发生肺炎的风险。因此，应采取策略减少吸入物的体积和致病性。例如，由于吞咽和咳嗽反射都是由内源性P物质介导的，使用血管紧张素转换酶抑制剂进行药物治疗，减少P物质的分解代谢，可能改善这两种反射，从而降低肺炎的风险。同样，由于P物质的产生是由大脑基底神经节中的多巴胺能神经元调节的，用多巴胺类似物或金刚烷胺等预防药物治疗（当然，还有预防脑血管疾病，这可能导致基底神经节中风）应该会影响肺炎的发病率。本综述的目的是考虑有希望的药物治疗作为预防老年人肺炎的方法，并回顾其他已证实的策略，例如感染控制和脑血管疾病预防，这些策略将降低肺炎的发病率。

Aspiration of oropharyngeal bacterial pathogens to the lower respiratory tract is one of the most important risk factors for pneumonia ; impairments in swallowing and cough reflexes among older adults, e.g., related to cerebrovascular disease, indreses the risk for the development of pneumonia. Thus, strategies to reduce the volumes and pathogenicity of aspirated material should be pursued. For example, since both swallowing and cough reflexes are mediated by endogenous substance P, pharmacologic therapy using angiotensin - converting enzyme inhibitors, which decrease substance P catabolism, may improve both reflexes and result in the lowering of the risk of pneumonia. Simirarly, since the production of substance P is regulated by dopaminergic neurons in the cerebral basal ganglia, treatment with dopamine analogs or portentiating drugs such as amantadine (and, of course, prevention of cerebral vascular disease, which can result in basal ganglia strokes) should affect the incidence of pneumonia. The purpose of this review is to consider promising pharmacologic treatments as methods of preventing pneumonia in older adults and to review other proven strategies, e.g., infection control and cerebrovascular disease prevention that will lesson the incidence of pneumonia.