Capsaicin lozenge may prevent aspiration in elderly

Letting a lozenge containing capsicin, an ingredient derived from red peppers, dissolve in the mouth before meals improves the reflexes of the upper respiratory system, which may help prevent aspiration and pneumonia in the elderly, the results of a Japanese research suggest.

Aspiration of food and/or drink is a common cause of pneumonia in older people, lead investigator Dr. Takae Ebihara and colleagues point out in their study, published in Journal of the American Geriatric Society. They theorize that capsaicin could increase concentrations of substance P in the throat. Increased levels of substance P, which is associated with the swallowing reflex, may prevent aspiration.

The research team, based at the Tohoku University School of Medicine in Sendai, enrolled 64 nursing home patients, average age 82 years, in their study. The subjects were randomly assigned to receive capsaicin or a placebo lozenge for four weeks, to be dissolved in the mouth before every meal.

Caregivers and study volunteers carefully observed the participants who had dementia as they dissolved the lozenge in their mouth, the researchers note.

The swallowing reflex was assessed by injecting a small amount of water into the throat through a nasal catheter and measuring the time until swallowing.

At the beginning of the study, the time to swallowing averaged 5.7 seconds in the capsicin group and 5.4 seconds in the placebo group. The investigators note that a latency of 5 seconds puts a patient at high risk for the development of pneumonia.

After four weeks, the time to swallowing was 3.5 seconds in the capsaicin group and 5.7 seconds in the placebo group, a statistically significant difference, Ebihara's group found.

The results of this study may provide the basis for additional trials of treatment with capsaicin lozenges in the elderly who have significant impairments in their swallowing reflex, the investigators conclude.

SOURCE: Journal of the American Geriatric Society, May 2005.