7 Tips for Preventing Reflux and Aspiration

Dr. Gwen A. Huitt, an infectious disease doctor with a special interest in mycobacteria and cystic fibrosis, spoke in our last article about what aspiration is and how it’s dangerous to CF patients.

“Aspiration is defined as any liquid, substance, or foreign body that gains access (below the vocal cords) to the airways,” Dr. Huitt said. “The dangers of aspiration for CF or non-CF patients are that you are sending not only germs such as pseudomonas or non-tuberculosis mycobacteria (NTM) into the airway that contribute to infection, but also that digestive enzymes and acids cause significant inflammation in the airways.”

The following are her top seven tips for preventing aspiration:

1. Limit liquids to no more than six ounces per hour. A liquid includes smoothies, yogurt, soup, ice cream, etc.
Do not consume liquids within three hours of bedtime.

2. Move bedtime meds to evening meal (except for sleeping medication).

3. Sleep elevated — preferably on an adjustable bed with upper body elevated between 30 to 45 degrees and the knees slightly elevated and flexed. Merely sleeping on two pillows is not enough.

MORE: Virtual reality used in hospital for cystic fibrosis ‘distraction therapy’

4. Never sleep on your right side or stomach. This increases reflux at night. Switch sides of the bed if necessary so you will not sleep on your right side.

5. Avoid these products as they all will make silent reflux worse for several hours:

• • Alcohol
  • Caffeine
  • Carbonated beverages
  • Chocolate
  • Fatty foods
  • Tomato sauces

6. Remember there is no medication that stops reflux! Medications only lower the acid content in the stomach juices.

• “Medications such as PPI [i.e. Nexium] or H2 blocker [i.e. Zantac] medications suppress acid production, which certainly can help with heartburn or cough, but they do not stop the physical action of reflux.”
• “Part of the action of acid in digestive juices is to kill some proportion of germs that we swallow. If you are still refluxing (while taking PPIs) and you then aspirate some of this digestive “soup”, you are actually aspirating more germs”

7. Only carbohydrates, grains, and starches absorb stomach liquids enough that they will not easily reflux high enough into the esophagus to be aspirated into the lungs.

MORE: Why aspiration is a silent hidden danger for cystic fibrosis patients

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