Foreign body aspiration

Last reviewed: 3 Sep 2022

Last updated: 18 Aug 2020

Inhalation of a foreign body into the larynx and respiratory tract.

Symptoms include sudden onset of respiratory distress associated with coughing, gagging, or stridor. Unilateral wheezing suggests partial obstruction of the main or distal bronchi.

Major causes of foreign body aspiration are altered mental status from alcohol or sedative use; seizure; neurologic disorders; trauma associated with a decreased level of consciousness; dental procedures; advanced or young age; and disorders associated with dysphagia and impaired cough reflex.

Flexible bronchoscopy confirms suspected cases of foreign body aspiration and can be used to attempt removal of the foreign body. Rigid bronchoscopy is performed if flexible bronchoscopy fails.

Definition

Foreign body aspiration is the inhalation of a foreign body into the larynx and respiratory tract.[1]

History and exam

Key diagnostic factors

choking crisis
unilateral decreased breath sounds
unilateral wheezing

More key diagnostic factors

Other diagnostic factors

intractable cough
fever
dyspnea
bilateral wheezing

Other diagnostic factors

Risk factors

decreased level of consciousness (Glasgow coma score <9)
age <4 years
age >70 years
bulbar dysfunction
male sex
cerebrovascular disease
dementia

More risk factors

Diagnostic investigations

1st investigations to order

chest x-ray

More 1st investigations to order

Investigations to consider

CT chest
bronchoscopy

More investigations to consider

Treatment algorithm

ACUTE

conscious

unconscious

Contributors

Authors

Arjun B. Chatterjee, MD, MS, FACP, FCCP, FAASM

Professor of Medicine

Section on Pulmonary, Critical Care, Allergy, and Immunologic Disease

Wake Forest University School of Medicine

Winston-Salem

Disclosures

ABC declares that he has no competing interests. His opinions are his own and do not represent those of his employers: Wake Forest University School of Medicine; US Department of Defense - United States Navy; US Department of Veteran’s Affairs.

Acknowledgements

Dr Arjun B. Chatterjee would like to gratefully acknowledge Dr Septimiu Murgu and Dr Henri Colt, the previous contributors to this topic. SM and HC declare that they have no competing interests.

Peer reviewers

Amber Young, BSc, MB ChB, FRCA

Consultant Paediatric Anaesthetist

Department of Anaesthesia

Frenchay Hospital

Bristol

Disclosures

AY declares that she has no competing interests.

Momen M. Wahidi, MD, MBA

Director

Interventional Pulmonology

Division of Pulmonary, Allergy, and Critical Care Medicine

Assistant Professor of Medicine

Duke University Medical Center

Durham

Disclosures

MMW declares that he has no competing interests.

Pyng Lee, MD

Senior Consultant

Department of Respiratory and Critical Care Medicine

Singapore General Hospital

Singapore

Disclosures

PL declares that he has no competing interests.

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Guidelines
- European Resuscitation Council guidelines 2021: Executive summary
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Patient leaflets
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Foreign body aspiration

Summary

Definition

History and exam

Key diagnostic factors

Other diagnostic factors

Risk factors

Diagnostic investigations

1st investigations to order

Investigations to consider

Treatment algorithm

conscious

unconscious

Contributors

Authors

Arjun B. Chatterjee, MD, MS, FACP, FCCP, FAASM

Disclosures

Acknowledgements

Peer reviewers

Amber Young, BSc, MB ChB, FRCA

Disclosures

Momen M. Wahidi, MD, MBA

Disclosures

Pyng Lee, MD

Disclosures

Differentials

Guidelines

Patient leaflets

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