Foreign Body Aspiration: Causes, Symptoms & Treatment

Foreign body aspiration occurs when foreign bodies enter the respiratory organs and passages. In the majority of cases, foreign body aspirations occur in young children. In principle, however, foreign body aspiration may occur in persons of all ages. In a large proportion of patients, foreign body aspiration results from the ingestion of food.

What is foreign body aspiration?

Foreign body aspiration differs in individual cases by its severity and potential for complications. Symptoms depend primarily on what type of foreign body, in what size, and how deeply it has entered the airway. The first sign of aspiration usually represents a whistling sound when breathing. If the airways are severely obstructed, patients suffer from a cough that can no longer be stopped. In numerous cases, so-called hemoptysis also forms. If the supply of fresh respiratory air is severely impaired by aspiration of the foreign body, numerous affected individuals develop cyanosis or dyspnea.

Causes

The cause of foreign body aspiration is basically that an object enters the airway. Examples include pieces of food or toys. In many cases, foreign body aspiration occurs in young children who, for example, inhale various solids while eating or playing. Possible objects include bones, nuts, small stones, or components of toys. In adults, aspiration of foreign substances occurs mainly in such situations when the patient suffers from neurological disorders or is unconscious. As a result, the process of swallowing is impaired in numerous cases. Observations also show that inhalation of foreign bodies is often not noticed. This is true for both infantile and adult patients.

Symptoms, complaints, and signs

Foreign body aspiration is principally associated with various symptoms that differ minimally in each patient. Basically, the symptoms that occur individually depend strongly on three factors. These include the localization of the foreign body within the airway, the type and size of the foreign body, and the time interval between inhalation and the making of the diagnosis. With regard to the localization of inhaled foreign bodies, it is evident that the majority of foreign body aspirations are concentrated in the bronchi. Particularly often, the foreign bodies get stuck in the bronchial branches on the right side. The reason for this is that the main bronchial pathway descends more steeply on the right side than that on the left. With regard to the foreign body, the type, shape, size expansion as well as the constancy of the foreign substance are primarily decisive. If it is a contaminated substance, the risk of respiratory tract infections also increases considerably. In this context, for example, a so-called aspiration pneumonia is possible. Depending on its size and shape, the foreign substance may completely block the bronchial pathways. As a result, atelectasis develops in some cases. In other cases, the foreign body acts as a kind of valve, allowing air to be inhaled but not exhaled. In this case, there is a risk of hyperinflation. Finally, the time between foreign body aspiration and diagnosis plays an important role in the development and severity of symptoms and complications. The more time that elapses before diagnosis, the more likely it is that difficulties will develop as a result of foreign body aspiration. In particular, this increases the risk of superinfection. Inflammatory processes in the affected airways and surrounding areas also develop more easily. If removal of the foreign body from the airways does not occur, atelectasis and hemoptysis develop in many cases.

Diagnosis

Foreign body aspiration is diagnosed based on the presenting symptoms. First, the physician conducts an interview with the patient, analyzing the symptoms and the causes and circumstances of origin of the aspiration. Then, the physician examines the patient using various procedures. As a rule, the physical examination comes first, whereby the doctor examines, for example, the throat of the affected person.Another important method is imaging, which usually allows a reliable diagnosis of foreign body aspiration. In most cases, the area of the chest is x-rayed. In some patients, supplementary spirometry is used to confirm the diagnosis.

Complications

Foreign body aspiration results in death in the worst case scenario. In this case, very rapid and professional treatment by the emergency physician is necessary to prevent the patient from dying. Death occurs due to the reduced supply of oxygen. Since foreign body aspiration can occur in age groups alone and with different objects, the complications are very different. Generally, panic attacks and gasping for breath occur. The organs and extremities receive less oxygen and may be damaged. The longer the undersupply occurs, the more they are damaged. The brain in particular can be severely affected, resulting in mental or psychological impairment after removal of the foreign body. Especially in young children and babies, the risk of foreign body aspiration is increased. It usually takes 13 minutes for the patient to die without oxygenation. Before that, he loses consciousness. It is not uncommon for surgical intervention to be necessary to remove the foreign body. If the foreign body was swallowed completely, problems can occur in the stomach. Here it depends strongly on the foreign body itself whether it must be surgically removed. Further complications can occur if toxic substances enter the oral cavity and thus the body during foreign body aspiration.

When should you go to the doctor?

If shortness of breath occurs, a doctor should always be consulted. If there is shortness of breath or the inability to take deep breaths, a doctor is needed. If the affected person has inhaled objects accidentally, urgent action is required. This is also the case if food or liquids are ingested into the trachea. If the foreign bodies get into the lungs, they can cause irreparable tissue damage. This impairs lung activity to a considerable degree. In severe cases, organ failure occurs, which without early medical treatment ends in the death of the affected person. In addition, the foreign bodies in the lungs can trigger pneumonia. This, too, can have a fatal outcome without prompt medical attention. If there is a persistent scratching in the trachea or spitting up of blood, a doctor must be consulted. If blood pressure rises or a racing heart sets in, a doctor’s visit is necessary. Dizziness, vomiting or nausea are signs that need to be examined by a doctor. If there are disturbances of consciousness, an emergency physician must be called. The sequelae of foreign body aspiration have triggered a critical health condition that requires immediate intensive care. If fever, panic or hysterical behavior occurs, a physician is needed. The behavior worsens the situation, so urgent help is needed.

Treatment and therapy

Foreign body aspiration is usually treated by removing the foreign substance in question from the airway area. In some cases, bronchoscopy is used for this purpose, using a tube to remove the foreign body from the airway. However, in some patients this method is not practical due to the location of the foreign body or other factors. In such cases, surgical intervention may be necessary to remove the foreign body. Antibiotics may be administered to patients with aspiration pneumonia. In general, timely diagnosis of foreign body aspiration and prompt subsequent removal of the foreign body greatly improve the prognosis for affected patients.

Outlook and prognosis

In foreign body aspiration, the prognosis depends on the parameters of age, location of the foreign body, and size of the inhaled foreign body. In favorable cases, the foreign body can be easily coughed up or removed from the trachea by the primary care physician. In case of breathing difficulties due to unfavorable position or larger size of the foreign body, an emergency physician must be called immediately. There is a risk of suffocation. If not the upper but the deeper airways are affected by foreign body aspiration, the prognosis is rather unfavorable. Although it may initially appear that everything has gone well.The inhaled foreign body can trigger inflammation in the bronchial tissue or become stuck in the trachea. If it starts moving again during coughing, there is an acute need for action. Foreign body aspiration is particularly dangerous in elderly or disabled people and young children. The mere suspicion of foreign body aspiration should therefore lead to an immediate visit to the doctor. The prognosis improves if the visit to the doctor is made quickly. This can prevent injury and inflammation. If necessary, the physician can remove the inhaled foreign body. The longer the doctor’s visit is delayed, the worse the prognosis. The foreign body can grow in and cause severe inflammatory reactions. The inflammation then often requires antibiotic therapy. Surgical removal of the foreign body may be required. Clinical monitoring is required in severe cases of foreign body aspiration with sequelae of injury.

Prevention

Prevention of foreign body aspiration focuses on avoiding inhalation of foreign substances. Attention is especially needed, for example, when ingesting food.

Follow-up

In most cases of foreign body aspiration, no follow-up care is necessary. Removal of the object that has entered the throat is usually sufficient. If necessary, subsequent sore throat is treated with sprays, lozenges, or gentling. If a small injury has occurred, it is recommended to avoid solid, hard food for a while and not to drink drinks that are too cold or too hot. Aftercare is only considered in two cases: First, there is the surgical intervention. This may be necessary due to the location of the foreign body or due to an obstruction in the neck. The aftercare is the same as for all other minor surgical interventions. It consists mainly of observation of healing over a short period of time and care of the wound or suture. A follow-up examination is rarely necessary. For major injuries due to foreign body aspiration, multiple follow-up visits may be necessary to assess healing and intervene medically if necessary. Otherwise, it may also be appropriate to prescribe antibiotics for follow-up care to prevent secondary infections. These could be caused by the object itself if it was contaminated, or the affected tissue may appear to the physician to be susceptible to infection.

Here’s what you can do yourself

Since foreign body aspiration occurs mainly in children, with regard to the relief measures that are carried out at home, it is mainly the parents or guardians who are responsible. However, since a foreign body should always be removed from the respiratory tract, the options for self-help are limited to the correct behavior in the event of foreign body aspiration. For example, if the person who swallowed the foreign body is still able to breathe, they should not be slapped on the back under any circumstances. The head should also not be lowered and the object should not be shaken out. Both carry the risk of the object shifting and causing serious problems in the new position. Removal in a hospital setting should be sought. Only if the swallower can no longer breathe must an attempt be made to gently force the object out of the airway. Head-down positions and tapping between the shoulder blades are useful for this purpose. It may be necessary to perform mouth-to-mouth resuscitation and chest compressions until the emergency physician arrives. Ventilation and chest compressions must be performed in any case of suspended breathing – regardless of whether the supervisors are confident in doing so. It is essential to act immediately in the event of impending asphyxiation