Inhalation injury

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Last reviewed: 20 Aug 2025

Last updated: 04 Jul 2025

Inhalation injury occurs when noxious stimuli such as heat, gases, or particulate matter come into contact with the respiratory system.

Residential fires and workplace accidents are common events that lead to inhalation injury.

Pathophysiology includes thermal injury, systemic absorption of toxic compounds, and direct cellular injury.

Clinical manifestations include upper airway obstruction, carbon monoxide poisoning, airflow obstruction, and acute respiratory distress syndrome.

Therapy is largely supportive, although targeted therapies are the subject of active investigation.

Long-term sequelae and complications are common.

Definition

Inhalation injury is a spectrum of clinical disease that occurs when the respiratory system is exposed to extreme heat or toxic substances.[1] These exposures occur most commonly in the setting of occupational chemical accidents and residential fires. The severity and pathogenesis of clinical disease depends upon the toxins present and the level of exposure. Acute disease severity can range from mild to fatal. Chronic consequences of inhalation injury are common.

History and exam

Key diagnostic factors

similarity of symptoms to those of others at site of exposure
cough
dyspnea
hoarseness or dysphonia
headache
dizziness
tachypnea
hypoxia
facial burns
upper airway edema
stridor
wheezing
crackles
loss of consciousness
seizures

Full details

Other diagnostic factors

tachycardia
hypotension
nausea

Full details

Risk factors

known inhalation exposure

Full details

Diagnostic investigations

1st investigations to order

pulse oximetry
arterial blood gas
carboxyhemoglobin (CO-Hb) level
chest x-ray
ECG
cardiac telemetry monitoring
urine toxicology screen
serum ethanol level

Full details

Investigations to consider

pulmonary function tests (PFT)
laryngoscopy and bronchoscopy
serum lactate

Full details

Emerging tests

cyanide level

Treatment algorithm

ACUTE

all patients

Contributors

Authors

Jason T. Poston, MD

Associate Professor

Section of Pulmonary and Critical Care Medicine

Department of Medicine

University of Chicago

Chicago

Disclosures

JTP declares that he has no competing interests.

Cathryn T. Lee, MD, MS

Instructor

Department of Medicine, Section of Pulmonary and Critical Care

University of Chicago

Chicago

Disclosures

CL has received grants from the Pulmonary Fibrosis Foundation.

Acknowledgements

Dr Jason T. Poston and Dr Cathryn T. Lee would like to gratefully acknowledge Dr Matthew R. Stutz, Dr Karen C. Dugan, and Dr John P. Kress, previous contributors to this topic. We would like to gratefully acknowledge the late Dr Ian R. Driscoll, Associate Professor of Surgery and Anesthesiology at the University of Florida College of Medicine and Director of the UF Health Shands Burn Center, for his peer review of this topic in 2024.

Disclosures

MRS, KCD, JPK, and IRD declared that they had no competing interests.

Peer reviewers

Leopoldo C. Cancio, MD

Critical Care Fellow

US Army Burn Center

US Army Institute of Surgical Research

Brooke Army Medical Center

Fort Sam Houston

Disclosures

LCC declares that he has no competing interests.

Rhys Thomas, MD

Honorary Consultant in Anesthesia and Intensive Care

Queen Victoria Hospital

East Grinstead

Honorary Consultant

Royal London Hospital

London

Disclosures

RT declares that he has no competing interests.

Brendan Madden, MD, MSc, FRCP, FRCPI

Professor of Cardiothoracic Medicine

St George's Hospital

London

Disclosures

BM declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

ISBI Practice Guidelines Committee, Steering Subcommittee, Advisory Subcommittee. ISBI practice guidelines for burn care. Burns. 2016 Aug;42(5):953-1021.Full text Abstract

Anseeuw K, Delvau N, Burillo-Putze G, et al. Cyanide poisoning by fire smoke inhalation: a European expert consensus. Eur J Emerg Med. 2013 Feb;20(1):2-9.Full text Abstract

Summerhill EM, Hoyle GW, Jordt SE, et al; ATS Terrorism and Inhalational Disasters Section of the Environmental, Occupational, and Population Health Assembly. An official American Thoracic Society Workshop report: chemical inhalational disasters. Biology of lung injury, development of novel therapeutics, and medical preparedness. Ann Am Thorac Soc. 2017 Jun;14(6):1060-72.Full text Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

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- Asthma
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Guidelines
- Guideline for inhalation injury in burns patients. Adult guidelines
- Management of airway burns and inhalation injury. Paediatric guidelines
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Inhalation injury

Summary

Definition

History and exam

Key diagnostic factors

Other diagnostic factors

Risk factors

Diagnostic investigations

1st investigations to order

Investigations to consider

Emerging tests

Treatment algorithm

all patients

Contributors

Authors

Jason T. Poston, MD

Disclosures

Cathryn T. Lee, MD, MS

Disclosures

Acknowledgements

Disclosures

Peer reviewers

Leopoldo C. Cancio, MD

Disclosures

Rhys Thomas, MD

Disclosures

Brendan Madden, MD, MSc, FRCP, FRCPI

Disclosures

Peer reviewer acknowledgements

Disclosures

References

Key articles

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Differentials

Guidelines

Patient information

Videos

Log in or subscribe to access all of BMJ Best Practice

Log in or subscribe to access all of BMJ Best Practice

Log in to access all of BMJ Best Practice