Aspiration

Aspiration is when something other than air gets into your airways. Often, it’s something that you meant to swallow or that belongs in your digestive tract. This could include:

• Food
• Water or liquid
• Stomach acid
• Vomit
• Mucus or saliva (spit) from your mouth or throat
• A foreign object

We often talk about aspiration as something “going down the wrong pipe.” In most situations, it might cause minor irritation while you cough out the wayward food or water. But in some cases, it can cause you to choke, restrict your breathing or cause an infection.

What are the symptoms of aspiration?

Symptoms of aspiration include:

• Coughing
• Feeling like something’s stuck in your throat
• Noisy breathing, like stridor or wheezing
• Shortness of breath (dyspnea) or difficulty breathing
• Bluish skin, lips, fingertips or nails (cyanosis)
• Trouble swallowing (dysphagia)
• Fever

Aspiration causes

Anytime your epiglottis — a piece of cartilage that works like a lid that closes over your vocal cords when you swallow — fails to protect your airways, you can aspirate. Conditions that reduce your cough or gag reflex can also cause aspiration. These reflexes protect you when something makes it past your epiglottis and into your airways.

You have two tubes that run down your neck and chest — one for food (your esophagus) and one for air (your larynx and trachea/windpipe). They join in your throat (pharynx). Most of the time, the path from your nose or mouth is open from your throat to your airways and down to your lungs, so you can breathe. But when you swallow, your epiglottis covers your airways so food and liquids go down your esophagus instead of your windpipe.

Sometimes your epiglottis doesn’t move to protect your airways, causing you to aspirate. If your body can’t clear a substance out of your airways (for instance, by coughing or clearing your throat), it can get stuck or cause an infection.

Risk factors for aspiration

Most of us experience moments where we accidentally aspirate something — maybe you took a sip of water just as something surprised you. Or small crumbs trickle down the wrong way. But some medical conditions and medications can increase your risk. These include:

• Sedatives. Prescription and non-prescription drugs and alcohol can cause sedation — which may feel like sleepiness or a lower level of consciousness. Opioids are a common example of a sedative drug.
• Central nervous system These can reduce your body’s natural reflexes that keep you from aspirating. Examples include stroke, brain tumors and Parkinson’s disease.
• Neuromuscular disorders. These are conditions that affect your nerves or muscles, like myasthenia gravis or Guillain-Barré syndrome. They can prevent your muscles from responding the way they should to prevent aspiration.
• GERD (gastroesophageal reflux disease) and gastrointestinal motility disorders. Conditions like GERD and achalasia can cause large amounts of acid to back up into your esophagus, which can spill over into your airways.
• Anatomical differences. Difference in the structure of your airways or esophagus, like a tracheoesophageal fistula, can make it easier for food and other substances to go the wrong way.
• Medical devices.Nasogastric (NG) tubes can get in the way of your epiglottis working properly.

Newborns are also at risk of meconium aspiration syndrome, where they breath in thick, sticky meconium just before or during birth.

What are the complications of aspiration?

If your body can’t clear out something you aspirated, it can cause serious complications, including:

• Aspiration pneumonia
• Lung abscess
• Acute respiratory distress syndrome (ARDS)
• Collapsed lung (pneumothorax)
• Air in the space between your lungs and chest wall (pneumomediastinum)
• Inflammation in your lungs (pneumonitis)
• Asphyxiation — airway blockages or large amounts of fluids can deprive your body of oxygen

Severe complications might be more likely to happen if you aspirate something without realizing it (silent aspiration) or if you have a lowered level of consciousness. For instance, if you throw up while under the influence of alcohol, sedative medications or non-prescription drugs.

How is aspiration diagnosed?

Depending on your symptoms and whether you remember aspirating something, a provider might diagnose aspiration or its complications with:

• Chest X-ray or CT scan
• Bronchoscopy
• Sputum culture

If you think you’ve aspirated something or you have a condition that makes it more likely that you could aspirate without knowing it, let your provider know.

How is aspiration treated?

Providers treat aspiration by removing the food or other substance if possible. They sometimes do this during a bronchoscopy. If you’re choking and need emergency treatment, they may use the Heimlich maneuver or other techniques to force it out.

They can also open your airways and treat complications with:

• Supplemental oxygen
• Bronchodilators
• Antibiotics

You might need ongoing treatment for underlying conditions that put you at higher risk for aspiration. You likely won’t need treatment if you cough up something you aspirated and don’t have any underlying medical conditions.

Can aspiration clear up on its own?

Your body can clear small amounts of liquid and particles from your lungs and airways. It does this by trapping particles in mucus and using hair-like structures (cilia) to push them out. Your body can also break it down and absorb it.

But larger amounts of food, liquid or other substances can grow bacteria, causing infections, especially if you have a compromised immune system. Aspirated stomach acid can damage your airways over time.

Can you prevent aspiration?

You can reduce your risk for aspiration by managing underlying conditions and taking steps to make food more likely to go the right way when eating and drinking. A speech therapist can help you with specific techniques to reduce your risk of aspiration. Some common recommendations include:

• Always sit upright when eating or drinking. Stay upright (at least a 45-degree angle) for an hour after eating.
• Cut your food into bite-sized pieces and chew it well before swallowing.
• Use effortful swallowing techniques. This is a technique where you swallow forcefully, using your throat muscles to push foods and liquids down.

When should I see my healthcare provider for aspiration?

If you have a condition that makes you more likely to aspirate, talk to your provider about how to prevent aspiration. They can tell you what symptoms to look out for and when to seek medical care.

When should I go to the ER?

Call 911 or seek emergency medical attention if:

• You can’t swallow normally
• You’re short of breath or feel like you can’t breathe
• Your skin, lips or nails are blue or purple
• You have chest pain
• You think food or an object is stuck in your throat or airway

What questions should I ask my doctor?

It might be helpful to ask your healthcare provider:

• What caused this?
• How can I reduce my risk for aspiration?
• What symptoms should I look out for?