History and exam
Key diagnostic factors
common
choking crisis
Sudden onset of choking and coughing classically described in children and usually reported by parent/caregiver.
The sensitivity of choking crisis for foreign body aspiration varies from 13% to 88%.[14]
unilateral decreased breath sounds
uncommon
unilateral wheezing
In children, sensitivity is reported to be 24%, specificity 100%, positive predictive value 100%, and negative predictive value 35%.[14] Other studies show lower specificity rates (84%).[45]
May present in adults as well, especially in patients who have had the foreign body for more than 1 month as estimated by history.[55]
Auscultation sounds: Expiratory wheeze
Auscultation sounds: Polyphonic wheeze
Other diagnostic factors
common
intractable cough
fever
Seen in 31% of children and adults with foreign body aspiration.[54]
dyspnea
Occurs in 26% of children and adults with foreign body aspiration.[54]
bilateral wheezing
Occurs in 26% of children and adults with foreign body aspiration.[54]
Auscultation sounds: Expiratory wheeze
Auscultation sounds: Polyphonic wheeze
Risk factors
strong
decreased level of consciousness (Glasgow coma score <9)
Decreased level of consciousness associated with trauma, use of sedatives or alcohol, general anesthesia, or neurologic disorders (i.e., brain tumors, seizure, Parkinson disease, intellectual disability, stroke) impairs the protective airway mechanisms and increase the risk for aspirating a foreign body.[4][8] Alcohol or sedative use and head trauma are leading causes of foreign body aspiration in adults.[8]
age <4 years
Children have a 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 uninhibited inspirations when laughing or crying.[14] Significant morbidity and mortality are seen in younger children (2 months to 4 years old) because of their narrow airways and immature airway protective mechanisms.[10][15][16]
age >70 years
The risk of aspiration is higher in older people, especially in and after the seventh decade, probably because of a higher prevalence of aging-associated degenerative neurologic and cerebrovascular disorders that can cause dysphagia and/or impaired cough reflex.[4][7][8]
Studies indicate that more than 50% of patients with acute food asphyxiation are ages 71 to 90 years.[9]
bulbar dysfunction
Bulbar dysfunction from corticobulbar pathway or brainstem neuron degeneration may cause abnormalities in the control and strength of the laryngeal and pharyngeal muscles and may cause dysphagia that can lead to aspiration of microorganisms, liquids, or food. Furthermore, bulbar muscle weakness prevents adequate cough to clear the airway if aspiration does occur.[20]
male sex
cerebrovascular disease
More than one third of patients with acute stroke have radiologic evidence of aspiration.[7] Abnormal swallowing increases the risk for aspiration.[7] Patients with dysphagia have delayed triggering of the pharyngeal motor response and decreased laryngeal elevation, resulting in poor coordination and timing of oral, pharyngeal, and laryngeal events during swallowing.[24]
dementia
Can cause impairment of the cough reflex and/or swallowing.
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