Physiological mechanisms and pulmonary protection strategies in aspiration
implications for speech-language pathology practice
DOI:
https://doi.org/10.23925/2176-2724.2026v38i1e74437Keywords:
Respiratory Aspiration, Immunity, Pneumonia, Aspiration, Deglutition Disorders, Speech-Language PathologyAbstract
Bronchoaspiration represents one of the main adverse outcomes in individuals with dysphagia, being associated with aspiration pneumonia, prolonged hospitalization, the need for ventilatory support, and increased mortality. Despite its relevance, Speech-Language Pathology still tends to approach aspiration predominantly as a dichotomous pathological event, rather than as a biological process regulated by intrinsic pulmonary defense mechanisms. The purpose of this text is to provide an updated and integrated description of the main physiological mechanisms involved in pulmonary protection—particularly cough, mucociliary clearance, the innate alveolar immune response, the role of pneumocytes, the lymphatic system, and microbial homeostasis—and to contextualize them in relation to bronchoaspiration and speech-language pathology practice. We discuss the implications of these mechanisms for the assessment, prognosis, and clinical management of dysphagia, emphasizing that treating swallowing disorders alone is not always sufficient to prevent aspiration pneumonia and other respiratory comorbidities. The text advocates for a broadened perspective that incorporates multiprofessional pulmonary protection strategies, including respiratory muscle training, airway clearance techniques, positive expiratory pressure devices, intensive oral hygiene, functional monitoring, and health education. Understanding these mechanisms should guide clinical practice, curriculum design, and future research, bringing Speech-Language Pathology closer to respiratory physiology and pulmonary immunology.
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Copyright (c) 2026 Guilherme Maia Zica, Maria Inês Rebelo Gonçalves
This work is licensed under a Creative Commons Attribution 4.0 International License.
