Inhaled foreign body
Definition | Aetiology | Pathophysiology | Risk Factors | Signs and Symptoms | Investigations | Management
Definition
Inhaled foreign body refers to the aspiration of a foreign object into the respiratory tract, leading to partial or complete airway obstruction, with potential for severe respiratory distress or secondary complications such as pneumonia.
Aetiology
- Accidental aspiration of food particles (e.g., nuts, seeds, grapes).
- Non food items (e.g., small toys, beads, coins).
- Neuromuscular disorders increasing aspiration risk.
- Poor chewing ability in young children.
Pathophysiology
- Obstruction may occur in the larynx, trachea, or bronchi (most commonly the right main bronchus).
- Partial obstruction may allow air movement but cause stridor, wheezing, or coughing.
- Complete obstruction leads to asphyxia and requires urgent intervention.
- Delayed presentation may result in infection, lung collapse, or chronic cough.
Risk Factors
- Age under 3 years (incomplete chewing and immature protective reflexes).
- Eating while laughing, crying, or running.
- Neurological or developmental conditions affecting swallowing.
- Lack of parental supervision during feeding or play.
Signs and Symptoms
- Acute symptoms:
- Sudden onset coughing, choking, or gagging.
- Stridor or wheezing (indicative of upper airway involvement).
- Cyanosis and respiratory distress in severe cases.
- Apnoea or loss of consciousness in complete obstruction.
- Delayed symptoms (missed diagnosis):
- Persistent cough.
- Recurrent pneumonia or localised wheeze.
- Unilateral decreased breath sounds.
Investigations
- Clinical assessment: history of choking event, examination for stridor or asymmetric breath sounds.
- Chest X-ray: may show air trapping, atelectasis, or a visible foreign body if radiopaque.
- Fluoroscopy: assesses dynamic airway collapse in subtle cases.
- CT scan: indicated if chest X-ray is inconclusive but suspicion remains high.
- Rigid bronchoscopy: definitive investigation and treatment.
Management
1. Immediate Management:
- Partial obstruction: encourage coughing if the child is stable.
- Complete obstruction: perform back blows and chest thrusts (infants) or Heimlich manoeuvre (older children).
- Emergency airway management: intubation or tracheostomy if conventional methods fail.
2. Definitive Management:
- Rigid bronchoscopy: gold standard for foreign body removal.
- Flexible bronchoscopy: used in selected cases for diagnostic purposes.
3. Post-removal Care:
- Monitor for airway oedema, aspiration pneumonia, or persistent symptoms.
- Consider prophylactic antibiotics if secondary infection is suspected.
4. Referral:
- Paediatrics: all cases of suspected inhaled foreign body should be urgently referred.
- Respiratory specialist: if there is persistent respiratory compromise or secondary complications.
- ENT: if upper airway obstruction requires specialised intervention.