Foreign body aspiration occurs when a foreign body enters the airway which can cause difficulty breathing or choking. Objects may reach the respiratory tract and the digestive tract from the mouth and nose, but when an object enters the respiratory tract it is termed aspiration. The foreign body can then become lodged in the trachea or further down the respiratory tract such as in a bronchus. Regardless of the type of object, any aspiration can be a life-threatening situation and requires timely recognition and action to minimize risk of complications. While advances have been made in management of this condition leading to significantly improved clinical outcomes, there were still 2,700 deaths resulting from foreign body aspiration in 2018. Approximately one child dies every five days due to choking on food in the United States, highlighting the need for improvements in education and prevention. Signs and symptoms
Signs and symptoms of foreign body aspiration vary based on the site of obstruction, the size of the foreign body, and the severity of obstruction. 20% of foreign bodies become lodged in the upper airway, while 80% become lodged in a bronchus. Signs of foreign body aspiration are usually abrupt in onset and can involve coughing, choking, and/or wheezing; however, symptoms can be slower in onset if the foreign body does not cause a large degree of obstruction of the airway. With this said, aspiration can also be asymptomatic on rare occasions.Classically, patients present with acute onset of choking.
Episodes of recurrent pneumonia in the same lung field should prompt evaluation for a possible foreign body in the airway.Whether or not the foreign body is removed, complications such as chemical bronchitis, mucosal reactions, and the development of granulation tissue are possible.Complications can also arise from interventions used to remove a foreign body from the airway. Rigid bronchoscopy is the gold standard for removal of a foreign body, however this intervention does have potential risks. The most common complication from rigid bronchoscopy is damage to the patients teeth. Other less common complications include cuts to the mouth or esophagus, perforation of the bronchial tree, damage to the vocal cords, pneumothorax, atelectasis, stricture, and perforation. Prevention

There are many factors to consider when determining how to decrease the likelihood of aspiration, especially in the extremely young and elderly populations.The major considerations in children are their developmental level in terms of swallowing and protecting their airway via mechanisms such as coughing and the gag reflex. Also, certain object characteristics such as size, shape, and material can increase their potential to cause choking among children. When there are multiple children in a shared environment, toys and foods that are acceptable for older children often pose a choking risk to the younger children. Education for parents and caretakers should continue to be prioritized when possible. This can be through positions such as pediatricians, dentists, and school teachers as well as media advertisements and printed materials.