Aspiration or ingestion is the penetration of a foreign body (food, fluid, objects) into the respiratory tract during inhalation. There is an increased risk of aspiration, especially for elderly or dependent people and younger children.

What is aspiration?

If foreign bodies enter the respiratory tract, a coughing reflex is usually triggered by which they are to be transported out of the organism again.

Aspiration refers to the ingestion of food, vomit or other debris into the tracheobronchial system during inspiration (inhalation). If foreign bodies enter the respiratory tract, a coughing reflex is usually triggered by which they are to be transported out of the organism again.

However, if this process of Abhustens unsuccessful, larger aspirated foreign bodies can block the trachea, so that the affected person no longer gets air (dyspnea) and threatens to suffocate. In addition, aspiration can be expressed by convulsive (spasmodic) breathing attempts as a result of cramping of the bronchial muscles (bronchospasm) and by a blue-gray discoloration of the skin (cyanosis) in atelectasis (ventilation deficit of one lung section).

Smaller foreign bodies can also penetrate into the lungs, damage the tissue structures there and, in addition to a ventilation deficit, cause local inflammatory reactions. As a result, aspiration pneumonia may develop, which can be particularly severe for the elderly, sometimes with a fatal outcome.

causes

Aspiration is favored by reduced tongue mobility (eg in Parkinson's disease), disturbed swallowing, increased vomiting or the presence of reurgitation (pathological backflow of gastric juice or chyme into the oral cavity).

There is also an increased risk of aspiration in people who have not eaten or who have been intubated for an extended period of time, those with certain neurological impairments (stroke, myasthenia gravis), or confused, elderly persons.

In addition, younger children who study their environment primarily by mouth have an increased risk of aspirating food (eg, peanuts), toys, or other smaller items such as coins.

Diseases with this symptom

  • Parkinson
  • achalasia
  • bronchial asthma
  • stroke
  • Foreign body aspiration
  • heatstroke
  • Myasthenia gravis pseudoparalytica
  • lung infection
  • reflux disease

Diagnosis & History

Aspiration is usually diagnosed on the basis of the "classic symptom triad" of coughing, reduced breathing and whistling. The present symptomatology partly correlates with the localization of the aspirated foreign body.

Thus, in an aspirated object in the trachea (trachea) or larynx (larynx) depending on the present constriction pronounced symptoms with inspiratory stridor (breathing sounds during inhalation) before, while a foreign body in the bronchial system after an initial coughing attack often only a slight degree of respiratory impairment caused.

In addition, coughing and recurrent respiratory tract infections may indicate chronic aspiration, where the foreign body has been present in the bronchial system for a long time.

The diagnosis is usually confirmed by a chest X-ray examination. With a timely removal of the foreign body aspiration usually has a good course. However, chronic aspiration may eventually lead to hemoptysis, lung abscess, bronchiectasis, pneumomediastinum, or pneumothorax.

complications

Aspiration can cause many complaints. Aspiration of a foreign body focuses on the rapid removal of this foreign body from the respiratory tract. However, if this is not the case, complications are likely to occur. If the aspirated foreign body is not removed in time, there is a high probability of an inflammatory reaction in the airways.

If this is the case, an antibiotic treatment is usually necessary. This is partly due to the fact that the foreign body is usually contaminated bacterially. On the other hand, the aspirated foreign body damages the mucosa, making it more susceptible to bacterial colonization. Especially with the aspiration of spicy foods, it can also cause violent reactions. If this is the case, the administration of an anti-inflammatory drug is indicated to suppress this reaction. However, the most dangerous complication of aspiration is suffocation. If the foreign body can not be coughed off and settles in the trachea, suffocation threatens.

Especially in children, the risk of asphyxiation due to aspiration is significantly increased. The aspiration of swelling things can also cause suffocation, as they can inevitably come into contact with liquid. Due to the mentioned complications, rapid help is required for aspiration. Aspiration of a foreign body can be an acute life-threatening emergency.

When should you go to the doctor?

The consultation of a doctor is to be decided individually with an aspiration. In most cases, there is a reflex coughing attack of the person concerned. The foreign bodies are transported from the trachea back into the mouth or spat out. The substance is removed in this way without further after-effects. Mostly no further damages remain.

If you still experience pain or discomfort, a check-up with the doctor is recommended. This can support the further course of treatment with medication or check whether there are foreign substances in the trachea. If the foreign body can not be removed on its own, the danger of suffocation without a visit to the doctor threatens. If the aspiration occurs in children, a doctor should be consulted immediately. The permanent retention of a foreign substance in the trachea leads to an increased risk of further diseases.

Therefore, it is highly recommended to consult a doctor if a consciously initiated cough remains unsuccessful. Too large is the risk of suffering from pneumonia or respiratory failure. If the aspiration occurs regularly and repeatedly, then various therapeutic measures can be very helpful. Swallowing therapy with a speech therapist or occupational therapist can bring about long-term changes and achieve success. The aim of an initiated therapy is the reduction or permanent healing of the aspiration.

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Treatment & Therapy

In many cases, the aspirated foreign body is transported by strong coughing by itself back to the outside. If this fails, first aid measures may be required. For this purpose, the affected person is struck vigorously with his flat hand between the shoulder blades in front bending position, to initiate a coughing of the aspirated foreign body.

Then, if the Abhustens fails, the Heimlich handle can be used, which is however controversial because of possible internal injuries (diaphragmatic rupture, injuries of the stomach wall). In the case of severe ventilation deficits (respiratory and cardiac arrest), resuscitation (CPR) may also be required. Aspirated foreign bodies which can not be removed by the methods described are usually extracted with optical forceps (upper respiratory tract) or endoscopically as part of a bronchoscopy (mirroring of the trachea and bronchi).

For this purpose, a thin, elastic tube with a camera and suction device (bronchoscope) is introduced through the trachea into the lower respiratory tract to suck up accumulated secretions and the aspirated foreign body. The extracted secretion is then examined microbiologically for pathogens that might have entered the respiratory tract with the aspirated foreign body. Prophylactically, antibiotics are used regardless of the microbiological result. In the case of chronic aspiration, antibiotic therapy is usually recommended prior to bronchoscopy.

Outlook & Forecast

Aspiration can lead to various complications that can even lead to death. As a rule, aspiration occurs especially in young children. They tend to put things in the mouth and choke on them. However, aspiration also often occurs in adults, such as when small objects are held in place by the mouth and the patient ingests them.

In most cases, the foreign body can be removed in time, so it does not cause inflammation. However, if the foreign body remains in the lungs for longer, it will die from suffocation. Therefore, in case of aspiration first aid measures should be taken immediately and an emergency physician should be called.

If the aspiration occurs in spicy or spicy foods, the bronchial system is heavily loaded and can become inflamed. These inflammations are treated with antibiotics and usually do not lead to further complications.

Often the aspiration itself is corrected by the body by the coughing out of the foreign body and does not lead to dangerous situations.

prevention

Under the so-called aspiration prophylaxis measures are summarized, which prevent the ingestion of food or other foreign bodies. These include, for example, the lack of fluid and nutrition in advance of plannable operations, upper body elevation during food intake in people in need of care, sufficient time for eating and drinking and adequate oral hygiene for removing food leftovers after eating. In addition, it should be avoided that infants come into contact with very small parts (nuts, coins, Lego bricks) to prevent aspiration.

You can do that yourself

For aspiration (swallowing) with dyspnea, an ambulance should always be switched on for safety. If the air is not completely gone, often already strong cough helps to remove possible foreign bodies and reduce the aspiration. Also, creating a nausea sometimes helps to remove things from the pharynx.

In general, it is initially possible to attempt to remove foreign bodies or liquids that have entered the trachea during swallowing by hand. If this fails and convulsive breathing attempts occur, the rescue service must be alerted. Until this happens, the upper body of the affected person should be bent forward. As an immediate measure can be triggered with strong blows against the shoulder blades, a coughing stimulus through which the foreign body is often ejected. If this does not help, the secrets should be used. In case of respiratory arrest further life-saving measures must be carried out. In addition, if possible, third parties should identify what the foreign body is to facilitate acute hospital treatment.

If swallowed as a result of an allergic reaction, it is important to stay calm and breathe slowly until professional help arrives. Ingestion in case of an asthma attack can be treated with an asthma spray. With regular aspiration for no apparent reason a doctor should be consulted.

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