Aetiology
Children are at high risk for foreign body aspiration because of poor chewing ability, their tendency to put objects in their mouths, the lack of posterior dentition, and vigorous inspirations when laughing or crying.[14]
Significant morbidity and mortality is seen in the younger age group (2 months to 4 years) because of the narrow airways and immature protective mechanisms.[15][16] The risk is higher in children with intellectual disability with known swallowing difficulties, and also in boys.[14]
The major causes of foreign body aspiration in adults are:[4][7][8][9][17]
Altered mental status from alcohol or sedative use
Trauma associated with a decreased level of consciousness
Dental procedures involving single-tooth cast or pre-fabricated restorations involving cementation
Advanced age
Disorders associated with dysphagia and impaired cough reflex (e.g., cerebrovascular disorders, epilepsy, and degenerative neurological disorders such as amyotrophic lateral sclerosis, Alzheimer's disease, and Parkinson's disease)
Medications such as anticholinergics, antipsychotics, and anxiolytics
Inadequate chewing or swallowing of food with concomitant rapid inhalation due to laughter or sobbing.
Loose items unintentionally introduced into the airway during intubation, ventilation, or advanced airway management can lead to partial or complete airway blockage or obstruction.[18]
Pathophysiology
A higher prevalence of cerebrovascular and degenerative neurological disease explains why increased age is a risk factor for aspiration. These conditions result in both dysphagia and impaired cough reflex, which increase the risk of aspirating foreign bodies.[4][7][8] Anticholinergics, antipsychotics, and anxiolytics can impair the cough reflex and/or swallowing.
Symptoms from aspirated foreign bodies depend on the size, shape, and nature of the object, and the duration, degree, and location of airway obstruction. Symptoms may be non-specific (e.g., cough, wheezing, fever, dyspnoea, or tachypnea) or suggestive of severe or life-threatening airway obstruction (e.g., stridor).[4][19] A large object can completely occlude the trachea and result in asphyxiation and death, whereas small objects can lodge in the lower lobar airways and cause wheezing and cough and, eventually, atelectasis, post-obstructive pneumonia, bronchiectasis, or lung abscess. In some instances, intermediate size obstruction may mislead the provider into making an empiric diagnosis, such as asthma, reactive airways disease, bronchitis, or pneumonia.
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