Understanding Aspiration

Published September 20th, 2021 by Chris Riley
Fact Checked by
Jacqueline Hensler
Medically Reviewed:
Dr. Angel Rivera

What is Aspiration? | Causes | Symptoms | In Children | Diagnosis | Treatment | Prevent Aspiration

Aspiration is a medical condition that occurs when food or liquid enters the airway. It can be dangerous because it can lead to pneumonia, called aspiration pneumonia, choking, and even death. Aspiration in children has a different set of causes than aspiration in adults. In this article, we will discuss what aspiration is, how you diagnose aspiration, the causes, symptoms, and how you treat it, what the condition is like in children, and how you prevent aspirating from occurring. 

What is aspiration?

Aspiration is a medical condition that occurs when food or liquid enters the airway. In other words, it means that something has been drawn into the lungs from the mouth or nose. Aspiration can be caused by some medical conditions and also certain substances entering the body through inhalation. 

Aspiration works both ways within your body. You can inhale or drink something and it "goes down the wrong tube," meaning it follows the path of your airways. There is also aspiration where your stomach sends fluids, like bile that causes heartburn, the wrong way back up the esophagus. This also occurs when you vomit. 

If you have difficulty swallowing, as seen in higher numbers among children and older people, then you suffer from dysphagia. This condition can lead to higher numbers of people who aspirate. Please consult your healthcare provider if you believe this may be affecting you. 

What causes aspiration?

Aspiration can be caused by some medical conditions and also certain substances entering the body through inhalation. Aspiration can occur when you inhale your food instead of swallowing it properly or even if fluid goes down the wrong way. This condition has a higher risk for older adults who have higher rates of other diseases like Parkinson's disease which causes muscle stiffness that makes eating more difficult than usual. The following examples are the most common reasons people aspirate:

  • Difficulty swallowing
  • Loss of the gag reflex (the ability to feel when food is in your throat) 
  • Reduced alertness due to drugs, alcohol, or anesthesia from surgery

Some diseases and disorders: 

  • Alzheimer's disease 
  • Parkinson's disease 
  • Extreme obesity, having an extremely high BMI 
  • Cerebral palsy 
  • Muscular dystrophy
  • Multiple sclerosis or other muscle-wasting conditions 
  • Strokes, causing aspiration by limiting swallowing ability 

Aspiration often occurs after some types of surgery where anesthesia and narcotic pain medications were used, slowing breathing. This reduces coughing reflexes so mucus doesn't come up through air passages since it's being pushed down toward the lungs blocked by drugs within the body instead.

Finally, if you have an upper gastrointestinal bleed it will lead to a loss of oxygen which can result in aspirating stomach contents into your lungs causing pneumonia. Certain medications like opioids may also affect the part of the brain responsible for keeping food out of our airway so make sure to talk with your healthcare provider about any concerns regarding this issue. 

What are the symptoms of aspiration?

Symptoms of aspiration depend on how much and what you aspirated. If it is a small amount, the symptoms may be minor or even go unnoticed. 

Some common symptoms are: 

  • Coughing
  • Wheezing 
  • Gurgling sounds when breathing, also called stridor
  • Shortness of breath
  • Chest pain 
  • Vomiting after meals or drinks

The most serious symptom is sudden difficulty breathing which means that your airway has become blocked by fluid or food particles. This can lead to choking and emergency medical help is needed immediately. You should also seek immediate attention if there's blood present in your sputum, which is your saliva and mucus, as this could mean an upper respiratory infection like pneumonia. Aspiration can also cause nausea and fever. Again, these are not specific to aspiration and can be caused by other issues as well, so if you are experiencing these symptoms it is important to see your healthcare provider.

It is important to reiterate that food particles can also block your airways completely so you will not be able to breathe. This is a medical emergency and you should NOT try to clear your airway yourself as you can actually push the food further into your lungs causing severe damage. Please call for emergency help immediately if this is happening or perform the Heimlich maneuver on yourself, or preferably, have someone perform it on you.

Symptoms vary depending on what causes it. If you have inhaled saliva then you may have coughing and choking, though there will likely be no pain because nothing was forced down far enough past your windpipe. If fluid enters further then that can cause pneumonia or breathing difficulties as well as intense chest pain which doctors call pleurisy that occurs with each breath. Many people also suffer from fever after aspirating something into their lungs. If the aspirated substance is toxic then it can cause chemical pneumonitis which results in coughing, fever, and even fluid buildup around your organs called edema.

If you are not sure if someone has aspirated something or simply swallowed too much they may show signs of confusion or agitation though this isn't always present before aspiration occurs. Some people also have difficulty breathing with a rattling sound when inhaling known as rhonchi. When stomach contents are sent up to the wrong place they will usually last for about eight hours after ingestion so doctors generally try to keep track of that time frame just in case.

What is aspiration in children?

Aspiration is more likely to occur in children than adults because of anatomy and physiology. Children are much smaller which means that they have less muscle mass, making it difficult for them to protect their airways from foreign bodies. The larynx, also known as the voicebox, sits low in a child's neck at only four centimeters versus seven centimeters in an adult. Aspiration can lead to serious complications such as pneumonia or even death so early diagnosis and treatment are very important. Aspiration may also occur with infants who have had surgery done on their mouths or throats. Other common causes for aspiration in children include cleft palate and various neuromuscular diseases.

Other potential causes for aspiration in children include but are not limited to:

  • Tracheoesophageal fistula (TEF) is where part of the esophagus ends abnormally low in the chest cavity next to an opening in the wall between the mouth and windpipe or trachea. 
  • Esophageal atresia where the mouth does not connect to the stomach.

Diagnosing aspiration in infants is often done by means such as an X-ray or CT scan which will show whether there is something obstructing breathing passages. If this isn't clear based on images alone then doctors can also look for clinical signs such as labored breathing when inhaling and exhaling that may be present even during rest, cyanosis which is blue coloring of the lips or skin due to lack of oxygen, and wheezing.

How do you diagnose aspiration?

One problem with diagnosis is that there really aren't any early warning signs unless something falls onto your windpipe, the passage from your mouth to lungs. If you get food down your trachea then things may progress rapidly due to lack of oxygen getting through since breathing is impeded.

In order for you to get diagnosed with aspiration, you must first have symptoms such as coughing up mucus from your airway due to fluid build up within it. If this happens and it is not a choking emergency, then a doctor should listen carefully for any rattling sound when you breathe known as rales through a stethoscope before using another test called bronchoscopy. Through this, a doctor can see what is going on inside your airways and pass instruments down to take samples if necessary.

How do you treat aspiration?

Treatment for aspiration depends on the severity and many other factors such as your age, along with how long it has been present before being diagnosed. In infants where there are respiratory problems, treatment may involve medicines such as antibiotics or supplemental oxygen to ensure that their lungs stay healthy until they reach an older age. Risk goes down with age due to growth in anatomic structures within the body cavity which prevent foreign material from entering into air passages. For cases involving adults who have aspirated objects without any complicating conditions, then doctors will often attempt removal at home first through coughing maneuvers combined with a suction or any other methods they may have at their disposal. If this doesn't work then more invasive options such as bronchoscopy or even surgery will be recommended so doctors can see what is going on inside your body and remove any foreign objects that are obstructing breathing passages.

Can you prevent aspiration?

Aspiration can sometimes be prevented by following some simple steps for adults. These steps include:

  • Do not drink alcohol if you are taking medications that can cause drowsiness or breathing problems. 
  • Talk to your doctor about how medication might affect your ability to swallow. Some of these drugs can make it hard to swallow, which increases your risk of aspirating food into your lungs and developing pneumonia. 
  • Eating small amounts at a time so there is less room in your stomach for food particles. 
  • Chewing sticky foods like caramels carefully before swallowing.  
  • Always eat over a plate with no napkin covering down on top of it as this could create food crumbs that will be inhaled by accident when eating messy foods such as pizza or french fries. 
  • Do not eat while driving. 
  • Never drink with a straw as this forces the food down your throat more quickly and can lead to aspiration if you have difficulties swallowing. 

You should stay alert if you do not feel well and seek medical attention immediately when symptoms arise versus waiting for them to worsen.

One way to prevent aspiration is by means of a medical procedure known as endotracheal intubation which involves inserting a tube down the nose and into the throat so that you can breathe through it. This helps keep foreign objects out while also allowing oxygen to flow more freely than before so you don't suffocate on food particles or fluids within your air passages.

This is done if you are at high risk from neuromuscular diseases like amyotrophic lateral sclerosis, multiple sclerosis, muscular dystrophy, spinal cord injuries, Parkinson's disease, or if you are recovering from having major surgery done on your throat or mouth where breathing tubes were used during surgeries since there may still be leftover material within the airways that needs to be suctioned out or removed. You will then be fed either intravenously or through a feeding tube. 

It is always important to follow the advice given by your doctor on how best to prevent aspiration in children since some strategies used with adults will not apply or work properly on smaller bodies. A lot has been said about what foods are good vs bad for kids but this doesn't mean they need a restricted diet; rather, parents should watch out for choking hazards like grapes, nuts, etc., provide nutritious meals at regular intervals for proper nutrition to prevent children from gorging themselves and eating fast, and keep an eye on how much their kids are playing while eating to ensure there is no risk of choking or aspiration.

Other preventative measures against aspiration in children include but are not limited to avoiding placing small objects into your child's mouth which could easily choke them if swallowed incorrectly, not feeding your child when laying flat in bed since it causes risk for choking due to gravity pulling food downward within the throat, and feeding your child in an upright position where there is less risk of food getting into their windpipe.

As always, please seek medical assistance if you believe you or your child are suffering from aspiration or if you have any further questions regarding it. 

Summary

Aspiration is the inhalation of items into the airway. It can lead to choking or pneumonia for adults and children, respectively. There are ways to prevent aspiration in both age groups which include avoiding certain foods, feeding your child upright rather than laying down while eating, cutting food into small pieces, etc. In extreme circumstances, aspiration may also be treated with medical procedures such as endotracheal intubation that involves inserting a tube into your nose and throat so you may breathe through it effortlessly should other methods fail to work properly, although this is rare in healthy adults. 

Sources: 

MedlinePlus – Aspiration

National Institute of Health – Aspiration Risk 

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