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Shelter‐Acquired Pneumonia After a Catastrophic Earthquake in Japan

daily. Her swallowing reflex latency time normalized after ACE inhibitor treatment. She had been hospitalized three times because of COPD exacerbations in the previous year and experienced two exacerbations during the 6.1 years of follow-up. In addition to the regular treatment of COPD, ACE inhibitor treatment improved the swallowing reflexes of these individuals and reduced the frequency of COPD exacerbations (from 3 to 0.46 per year in case 1, and from 3 to 0.33 per year in case 2). The patients had not recognized their impaired swallowing reflexes, because they were on entirely oral diets without complaints of dysphagia and had no prior history of symptomatic stroke or oropharyngeal or esophageal abnormalities. Aspiration is associated with impairment of swallowing and cough reflex, which is mediated through substance P. ACE inhibitors decrease the catabolism of substance P, resulting in prevention of aspiration and protection against pneumonia in older adults. The findings of the current study suggest that ACE inhibitors protect against aspiration tracheobronchitis and exacerbations of COPD. ACE inhibitors have also been demonstrated to have beneficial effects on the heart, although the follow-up examination of these individuals, including electrocardiogram and echocardiogram, did not indicate a significant change. The blood pressure of these individual did not decrease significantly during the follow-up period. Although symptomatic hypotension has been reported to be rare, one should be careful about adverse effects of ACE inhibitor treatment in older adults. ACE inhibitor therapy is a potential option for preventing COPD exacerbations in selected individuals with impaired swallowing reflexes. Large randomized controlled clinical trials will be useful.