Interventions to prevent pneumonia among older adults

口咽部细菌病原体吸入下呼吸道是肺炎最重要的危险因素之一;老年人吞咽和咳嗽反射受损，例如，与脑血管疾病有关，增加了患肺炎的风险。因此，应采取减少吸入物质的体积和致病性的策略。例如，由于吞咽和咳嗽反射都是由内源性P物质介导的，因此使用血管紧张素转化酶抑制剂的药物治疗可以改善这两种反射并导致肺炎风险的降低，所述血管紧张素转化酶抑制剂减少P物质的catalysts。同样，由于P物质的产生受大脑基底神经节中多巴胺能神经元的调节，因此使用多巴胺类似物或预示性药物（如金刚烷胺）进行治疗（当然，还包括预防可导致基底神经节卒中的脑血管疾病）应该会影响肺炎的发病率。本综述的目的是考虑有前途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，控制感染和预防脑血管疾病，将教训肺炎的发病率。

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.