Aspiration or swallowing is the entry of a foreign body (food, liquid, objects) into the airway during inhalation. The elderly or those in need of care, as well as younger children, are at increased risk for aspiration in particular.
What is aspiration?
If foreign bodies enter the respiratory tract, a cough reflex is usually triggered, by which they should be transported out of the organism again. Aspiration is the entry of food, vomit, or other foreign bodies into the tracheobronchial system during inspiration (inhalation). If foreign bodies enter the respiratory tract, a cough reflex is usually triggered, by which they are to be transported out of the organism again. If this coughing process is unsuccessful, however, larger aspirated foreign bodies can block the trachea, so that the affected person can no longer breathe (dyspnea) and is in danger of suffocating. Aspiration can also be manifested by convulsive (spasmodic) attempts to breathe as a result of cramping of the bronchial muscles (bronchospasm) and by a blue-gray discoloration of the skin (cyanosis) in the case of atelectasis (ventilation deficit of a section of the lung). Smaller foreign bodies can also penetrate into the lungs, damage the tissue structures there and cause local inflammatory reactions in addition to a ventilation deficit. As a result, aspiration pneumonia may develop, which can take a severe course with a sometimes fatal outcome, especially for the elderly.
Causes
Aspiration is favored by decreased tongue mobility (e.g., in Parkinson’s disease), impaired swallowing, increased vomiting, or the presence of reurgitation (pathologic reflux of gastric juice or food pulp into the oral cavity). There is also an increased risk of aspiration in people who have not eaten for a long period of time or who have been intubated, in people affected by certain neurological impairments (stroke, myasthenia gravis) and in confused, elderly people. In addition, younger children who explore their environment primarily by mouth are at increased risk for aspiration of food (eg, peanuts), toys, or other small objects such as coins.
Diseases with this symptom
- Parkinson’s disease
- Achalasia
- Bronchial asthma
- Stroke
- Foreign body aspiration
- Heat stroke
- Myasthenia gravis pseudoparalytica
- Pneumonia
- Reflux disease
Diagnosis and course
Aspiration is usually diagnosed by the “classic symptom triad” of cough, decreased breath sound, and whistling. In this context, the presenting symptomatology correlates in part with the location of the aspirated foreign body. For example, an aspirated object in the trachea or larynx may present with pronounced symptoms of inspiratory stridor, depending on the constriction, whereas a foreign body in the bronchial system often causes only a mild respiratory impairment after an initial coughing episode. In addition, coughing and recurrent respiratory infections may indicate chronic aspiration, in which the foreign body has been in the bronchial system for some time. The diagnosis is usually confirmed by chest radiography. If the foreign body is removed promptly, aspiration usually has a good course. However, chronic aspiration can lead to long-term hemoptysis, lung abscesses, bronchiectasis, pneumomediastinum, or pneumothorax.
Complications
Numerous symptoms can result from aspiration. When a foreign body is aspirated, the primary concern is the rapid removal of that foreign body from the airway. However, if this is not the case, complications are likely to occur. If the aspirated foreign body is not removed in time, there is a high probability of an inflammatory reaction in the airways. If this is the case, antibiotic treatment is usually necessary. One reason for this is that the foreign body is usually contaminated with bacteria. On the other hand, the aspirated foreign body damages the mucosa, which makes it more susceptible to bacterial colonization.In addition, violent reactions may occur, especially during the aspiration of highly seasoned food. If this is the case, administration of an anti-inflammatory drug is indicated to suppress this reaction. The most dangerous complication of aspiration, however, is choking. If the foreign body cannot be coughed up and becomes lodged in the trachea, there is a risk of suffocation. Especially in children, the risk of choking due to aspiration is significantly increased. Aspiration of swelling objects can also lead to choking, as these may inevitably come into contact with fluid. Because of the complications mentioned above, rapid assistance is required in the event of aspiration. Aspiration of a foreign body can be an acute life-threatening emergency.
When should you go to the doctor?
Consultation with a physician should be decided on an individual basis in the event of aspiration. In most cases, there is a reflexive coughing attack by the affected person. In this case, the foreign body is transported from the trachea back into the oral cavity or spat out. The substance is removed in this way without further after-effects. In most cases, no further damage remains. If pain or discomfort persists, a check-up with a doctor is recommended. He or she can take medication to support the healing process or check whether there are still foreign substances in the trachea. If the foreign body cannot be removed under its own power, there is a risk of suffocation without a visit to the doctor. If aspiration occurs in children, a doctor should be consulted immediately. Permanent retention of a foreign substance in the trachea leads to an increased risk of further illness. Therefore, it is highly recommended to seek medical attention if a deliberately initiated cough is unsuccessful. The risk of developing pneumonia or lung failure is too great. If aspiration occurs regularly and repeatedly, various therapeutic measures can be very helpful. Swallowing therapy with a speech therapist or occupational therapist can bring about long-term changes and achieve success. The goal of initiated therapy is to reduce or permanently cure aspiration.
Treatment and therapy
In many cases, the aspirated foreign body will be expelled on its own by vigorous expectoration. If this does not succeed, first aid measures may be indicated. For this purpose, the affected person is struck forcefully between the shoulder blades with the flat of the hand while bent forward to initiate expectoration of the aspirated foreign body. Subsequently, if coughing does not occur, the Heimlich maneuver can be used, although this is controversial because of possible internal injuries (rupture of the diaphragm, injury to the stomach wall). In cases of severe ventilation deficits (respiratory and cardiac arrest), resuscitation (resuscitation by cardiopulmonary massage) may also be required. Aspirated foreign bodies that cannot be removed by the methods described are usually extracted with optical forceps (upper airway) or endoscopically during bronchoscopy (reflection of the trachea and bronchi). For this purpose, a thin, elastic tube with a camera and suction device (bronchoscope) is inserted via the trachea into the lower airways to suck out accumulated secretions as well as the aspirated foreign body. The extracted secretion is then examined microbiologically for pathogens that may have entered the airways with the aspirated foreign body. Prophylactically, antibiotics are used regardless of the microbiological result. If chronic aspiration is present, antibiotic therapy is usually recommended in advance of bronchoscopy.
Outlook and prognosis
Aspiration can result in a variety of complications, including death. Usually, aspiration occurs mainly in young children. They tend to put objects in their mouths and choke on them. However, aspiration also occurs frequently in adults, such as when small objects are held with the mouth and the patient chokes on them. In most cases, the foreign body can be removed in time to prevent inflammation. However, if the foreign body remains in the lungs for a longer period of time, death will result from suffocation. Therefore, in the event of aspiration, first aid measures should always be taken immediately and an emergency physician called.If aspiration occurs with spicy or highly seasoned food, the bronchial system is severely stressed and may become inflamed. These inflammations are treated with antibiotics and usually do not lead to further complications. Often, aspiration itself is resolved by the body coughing up the foreign body and does not lead further to dangerous situations.
Prevention
Actions that prevent the swallowing of food or other foreign bodies are grouped under what is known as aspiration prophylaxis. These include, for example, fluid and food restriction in advance of scheduled surgery, elevation of the upper body during food intake in people in need of care, sufficient time to eat and drink, and appropriate oral hygiene to remove food debris after eating. In addition, infants should be prevented from coming into contact with small objects (nuts, coins, Lego pieces) to prevent aspiration.
What you can do yourself
In case of aspiration (swallowing) with difficulty breathing, always call an emergency physician to be on the safe side. If the air does not stay away completely, often already strong coughing helps to remove possible foreign bodies and reduce the aspiration. Also, creating a nausea sometimes helps to remove objects from the throat. Generally, an initial attempt can be made to manually remove foreign bodies or fluid that has entered the trachea during swallowing. If this does not succeed and there are convulsive attempts to breathe, the emergency medical services must be alerted. Until they arrive, the victim’s upper body should be bent forward. As an immediate measure, a coughing stimulus can be triggered with strong blows against the shoulder blades, which often expels the foreign body. If this does not help, the Heimlich grip should be used. If respiratory arrest occurs, further life-saving measures must be performed. In addition, third parties should determine what the foreign body is, if possible, to facilitate acute treatment in the hospital. If swallowing occurs as a result of an allergic reaction, it is important to remain calm and breathe in slow bursts until professional help arrives. Ingestion during an asthma attack can be treated with an asthma inhaler. If aspiration occurs regularly for no apparent reason, a physician should be consulted.
