Summary
Definition
Foreign body aspiration is the inhalation of a foreign body into the larynx and respiratory tract.[1][Figure caption and citation for the preceding image starts]: Loquat seed completely occluding the bronchus intermediusFrom the collection of Dr Septimiu Murgu and Dr Henri Colt; used with permission [Citation ends].
History and exam
Key diagnostic factors
- choking crisis
- unilateral decreased breath sounds
- unilateral wheezing
Other diagnostic factors
- intractable cough
- fever
- dyspnea
- bilateral wheezing
Risk factors
- decreased level of consciousness (Glasgow coma score <9)
- age <4 years
- age >70 years
- bulbar dysfunction
- male sex
- cerebrovascular disease
- dementia
Diagnostic tests
1st tests to order
- chest x-ray
Tests to consider
- CT chest
- bronchoscopy
Emerging tests
- ultrasound lung
Treatment algorithm
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
NC
Disclosures
ABC declares that he has no competing interests.
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
UK
Disclosures
AY declares that she has no competing interests.
Momen M. Wahidi, MD, MBA
Professor of Medicine
Pulmonary and Critical Care
Feinberg School of Medicine
Northwestern University
Chicago
IL
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.
Prashant Mahajan, MD, MPH, MBA
Professor of Emergency Medicine and Pediatrics
Vice-Chair
Department of Emergency Medicine
Chief
Pediatric Emergency Medicine
C S Mott Children's Hospital and University of Michigan Medical School
Ann Arbor
MI
Disclosures
PM declares that he has no competing interests.
Karima Lelak, MD
Clinical Assistant Professor
Department of Emergency Medicine and the Department of Pediatrics
C.S. Mott Children's Hospital
University of Michigan
Ann Arbor
MI
Disclosures
KL declares that she 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
Key articles
Boyd M, Chatterjee A, Chiles C, et al. Tracheobronchial foreign body aspiration in adults. South Med J. 2009 Feb;102(2):171-4. Abstract
Faro A, Wood RE, Schechter MS, et al. Official American Thoracic Society technical standards: flexible airway endoscopy in children. Am J Respir Crit Care Med. 2015 May 1;191(9):1066-80.Full text Abstract
Hewlett JC, Rickman OB, Lentz RJ, et al. Foreign body aspiration in adult airways: therapeutic approach. J Thorac Dis. 2017 Sep;9(9):3398-409.Full text Abstract
Perkins GD, Graesner JT, Semeraro F, et al. European Resuscitation Council Guidelines 2021: executive summary. Resuscitation. 2021 Apr;161:1-60. 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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