Aspiration

Overview

Aspiration is when food, liquid, saliva, or stomach contents enter the airway or lungs instead of passing down the esophagus into the stomach. People often describe it as something "going down the wrong way." A small, occasional event usually triggers a strong cough that clears the airway and causes no harm. Repeated or significant aspiration, however, can lead to choking or a lung infection.

Swallowing safely depends on a well-coordinated reflex that closes off the airway when we eat or drink. When that reflex is impaired, by a swallowing disorder, a stroke, reduced alertness, or reflux, material is more likely to be inhaled. Aspiration is especially important in older adults and people with neurological conditions, because it can cause aspiration pneumonia, a lung infection from inhaled material.

There are two broad situations to recognize. Witnessed aspiration is obvious: a person coughs, chokes, or gasps while eating or drinking. Silent aspiration is more subtle, because material slips into the airway without triggering a strong cough, so it may go unnoticed until signs of a chest infection appear. This is why recurrent or unexplained chest infections in someone with a swallowing problem should prompt thoughts of aspiration, even without an obvious choking episode.

Common Causes

Aspiration happens when the normal protection of the airway during swallowing breaks down:

• Swallowing difficulty (dysphagia): From stroke, Parkinson's disease, dementia, or other neurological conditions.
• Reduced alertness: From sedation, intoxication, anesthesia, or seizures, which blunt the protective reflexes.
• Acid reflux: Stomach contents from GERD can be inhaled, especially when lying down.
• Throat or esophageal problems: Such as narrowing or muscle disorders.
• Eating too quickly or talking while eating: Can cause occasional aspiration.
• Weak cough or muscle weakness: Making it harder to clear the airway.

Tube feeding and certain medications can also increase the risk.

Associated Symptoms

Aspiration may cause immediate symptoms or signs that develop over hours to days:

• Sudden coughing, choking, or gagging during or after eating or drinking
• A wet or gurgly voice after swallowing
• Difficulty breathing or wheezing
• Throat clearing or a feeling of food stuck in the throat
• Later signs of infection: fever, coughing up phlegm, and chest discomfort
• Recurrent chest infections in people with swallowing problems

Choking with the inability to cough, speak, or breathe is a life-threatening emergency. Aspiration followed by fever, breathlessness, and a productive cough may signal aspiration pneumonia that needs prompt treatment.

Diagnosis & Evaluation

A doctor evaluates aspiration based on symptoms, swallowing function, and any underlying conditions. Tests may include:

• Swallow evaluation: A speech-language therapist assesses how safely you swallow different textures.
• Imaging swallow studies: Special X-ray or scope tests that watch swallowing in real time to see if material enters the airway.
• Chest X-ray or CT: To check for signs of aspiration pneumonia or lung damage.
• Tests for reflux: If stomach contents are the likely source.

This identifies the cause and guides steps to make swallowing safer and treat any infection.

Treatment & Management

Treatment focuses on preventing further aspiration and treating any infection:

• Swallowing therapy: Techniques, exercises, and positioning taught by a speech-language therapist.
• Diet modification: Changing food textures or thickening liquids when recommended for safer swallowing.
• Treating reflux: Lifestyle changes and medication to reduce reflux that can be aspirated.
• Treating aspiration pneumonia: Antibiotics and supportive care if a lung infection develops.
• Safe eating practices: Sitting upright to eat, eating slowly, taking small bites, and staying upright afterward.
• Managing underlying conditions: Such as stroke or neurological disease that affect swallowing.

For choking, first aid such as back blows and abdominal thrusts can be lifesaving while emergency help is sought.

When to See a Doctor

Call emergency services immediately if someone is choking and cannot cough, speak, or breathe, turns blue, or loses consciousness. This is a life-threatening airway emergency, and choking first aid should be started right away while help is on the way.

See a doctor promptly if you or someone you care for frequently coughs or chokes when eating or drinking, has a wet voice after swallowing, or develops a fever, breathlessness, and a productive cough after a choking episode, which may indicate aspiration pneumonia. Recurrent aspiration or swallowing difficulty should always be evaluated.

Related Topics

Frequently Asked Questions

References

1. Mayo Clinic. Aspiration and dysphagia (swallowing problems).
2. American Speech-Language-Hearing Association (ASHA). Swallowing Disorders (Dysphagia).
3. MedlinePlus, U.S. National Library of Medicine. Aspiration.
4. National Heart, Lung, and Blood Institute (NHLBI). Pneumonia.