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Entry of Food and Liquids in The Airways Symptoms & Causes

Food and liquids entering the airways can be dangerous—find out how this happens and ways to get relief.
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Last updated June 17, 2022

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9 most common causes

COPD
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Parkinson's Disease
Bronchitis
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Transient Ischemic Attack
ALS
GERD
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Achalasia
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Multiple sclerosis (MS)
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Esophageal obstruction (steakhouse syndrome)

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Entry of food and liquids in the airways symptoms

Aspiration means the inhalation, or breathing in, food, liquid, or anything else such as gastric contents. The substance(s) may only go as far as the airway (trachea or windpipe), or it may go all the way into one or both lungs. This will stimulate an immediate, involuntary reaction of violent coughing as the body attempts to get the foreign substance out of the sensitive airways. Aspiration is not choking.

Characteristics of Aspiration

Aspiration can be acute or chronic, which are described below, as well as silent. Silent aspiration means there are few or no symptoms except for recurrent pneumonia. This is most common in people with a prior stroke or dementia.

Acute aspiration

Acute aspiration means the sudden inhalation of food, drink or gastric (stomach) contents. It may involve:

Chronic aspiration

Chronic aspiration means small amounts of food or drink find their way into the lungs over time due to constant difficulty swallowing. It may involve:

  • Recurrent cases of pneumonia
  • Milder coughing or wheezing after eating
  • Feeling that food is caught in the throat after eating
  • Constantly clearing the throat during and after eating
  • Voice changes: A voice that sounds "wet," gurgling, or congested
  • Chronic, unexplained fevers: Especially right after eating

Other characteristics

Other characteristics and symptoms that may arise with aspiration include:

  • Dehydration: The person may avoid drinking liquids due to fear of aspirating.
  • Malnutrition and unexplained weight loss: The person may avoid eating as much as possible due to fear of aspirating.

Who is most often affected by aspiration?

People who are most likely to experience aspiration include:

When are aspiration symptoms most likely to occur?

Aspiration is likely when eating or drinking and:

  • Doing so too quickly
  • Being distracted, upset, or nervous
  • While under the influence: Of alcohol, illicit drugs, or medication

Are aspiration symptoms serious?

The severity of aspiration can vary.

  • Not serious: Occasional, brief coughing while eating or drinking is very common and is not serious.
  • Moderately serious: If any foreign substance gets into the lungs and stays there — even though the person is no longer in distress — it can cause inflammation, infection, and long-term damage to the lung tissue that must be treated by a medical provider.
  • Serious: If there is enough liquid in the lungs, the person can develop significant breathing problems if not treated immediately. If a piece of food or other solid substance becomes lodged in the lungs, it will cause severe irritation and difficulty breathing.

Entry of food and liquids in the airways causes

Causes of aspiration are described from most to least common below. Causes include dysphagia, stroke, oral or dental problems, neurologic illness, among others.

Dysphagia

This is a term for difficult or abnormal swallowing.

  • Swallow malfunction (dysphagia): This involves a malfunction in the system which normally closes off your airway when you swallow. When it remains partially open, food or liquid can get into the airway and travel down to the lungs.
  • Acid reflux: When there is acid reflux (also called gastroesophageal reflux disease (GERD) or heartburn), dysphagia may allow food or liquid to come back up from the stomach and enter the lungs that way.

Stroke

Strokes can cause damage to the parts of the brain which control reflexes — including the swallowing or "gag" reflex. This can lead to dysphagia and aspiration.

Oral or dental problems

Oral or dental problems can cause difficulty swallowing as the person tries to work around them.

  • Broken, missing, or painful teeth
  • Sores or other damage to the inner surface of the mouth

Neurologic illness

Neurologic illnesses can interfere with reflexes and muscle control. Normal swallowing requires both.

Rare and unusual aspiration causes

Rare and unusual causes of aspiration may include:

  • Birth injury: Oxygen deprivation can lead to brain damage and therefore a lack of proper swallowing reflexes and muscle control.
  • Birth defects: Cleft palate, for example, can make swallowing difficult.
  • Abnormal growths: Those in the throat and neck, and/or a history of receiving radiation treatments to the same area can lead to aspiration.

This list does not constitute medical advice and may not accurately represent what you have.

Stroke or tia (transient ischemic attack)

Transient ischemic attack, or TIA, is sometimes called a "mini stroke" or a "warning stroke." Any stroke means that blood flow somewhere in the brain has been blocked by a clot.

Risk factors include smoking, obesity, and cardiovascular disease, though anyone can experience a TIA.

Symptoms are "transient," meaning they come and go within minutes because the clot dissolves or moves on its own. Stroke symptoms include weakness, numbness, and paralysis on one side of the face and/or body; slurred speech; abnormal vision; and sudden, severe headache.

A TIA does not cause permanent damage because it is over quickly. However, the patient must get treatment because a TIA is a warning that a more damaging stroke is likely to occur. Take the patient to the emergency room or call 9-1-1.

Diagnosis is made through patient history; physical examination; CT scan or MRI; and electrocardiogram.

Treatment includes anticoagulant medication to prevent further clots. Surgery to clear some of the arteries may also be recommended.

Rarity: Common

Top Symptoms: dizziness, leg numbness, arm numbness, new headache, stiff neck

Symptoms that never occur with stroke or tia (transient ischemic attack): bilateral weakness

Urgency: Emergency medical service

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Parkinson's disease

Parkinson's disease is a lifelong condition movement disorder. It is caused by the malfunction and death of nerve cells which results in symptoms like tremors.

You should visit your primary care physician to discuss your symptoms.

Rarity: Rare

Top Symptoms: anxiety, depressed mood, difficulty concentrating, nausea, constipation

Symptoms that always occur with parkinson's disease: symptoms of parkinsonism

Urgency: Primary care doctor

Multiple sclerosis (MS)

Multiple sclerosis, or MS, is a disease of the central nervous system. The body's immune system attacks nerve fibers and their myelin covering. This causes irreversible scarring called "sclerosis," which interferes with the transmission of signals between the brain and the body.

The cause is unknown. It may be connected to a genetic predisposition. The disease usually appears between ages 20 to 50 and is far more common in women than in men. Other risk factors include family history; viral infections such as Epstein-Barr; having other autoimmune diseases; and smoking.

Symptoms include numbness or weakness in arms, legs, or body; partial or total loss of vision in one or both eyes; tingling or shock-like sensation, especially in the neck; tremor; and loss of coordination.

Diagnosis is made through patient history, neurological examination, blood tests, MRI, and sometimes a spinal tap.

There is no cure for MS, but treatment with corticosteroids and plasma exchange (plasmapheresis) can slow the course of the disease and manage symptoms for better quality of life.

Rarity: Rare

Top Symptoms: severe fatigue, constipation, numbness, decreased sex drive, signs of optic neuritis

Urgency: Primary care doctor

Esophageal obstruction (steakhouse syndrome)

When a large piece of food or an object gets stuck in the lower esophagus, it can produce some mild chest pain and excessive salivation (drooling).

Someone experiencing an obstruction of the lower esophagus should be monitored in a hospital setting. A number of steps can be taken involving swallowing certain treatments and sometimes IV medication before removing the food manually is necessary.

Rarity: Rare

Top Symptoms: vomiting, deep chest pain, behind the breast bone, trouble swallowing, choking, swallowing of something potentially harmful

Symptoms that always occur with esophageal obstruction (steakhouse syndrome): swallowing of something potentially harmful

Urgency: Hospital emergency room

Chronic obstructive pulmonary disease (COPD)

Chronic obstructive pulmonary disease (COPD) is a progressive inflammation of the lungs that makes breathing difficult. It is caused by long-term exposure to irritating gases and/or dust particles, most often cigarette smoke.

Symptoms may take years to develop. They include a chronic cough with mucus (sputum), wheezing, chest tightness, fatigue, constant colds, swollen ankles, and cyanosis (blue tinge to the lips and/or fingernails.) Depression is often a factor due to reduced quality of life.

Treatment is important because there is a greater risk of heart disease and lung cancer in COPD patients. Though the condition cannot be cured, it can be managed to reduce risks and allow good quality of life.

COPD is commonly misdiagnosed and so careful testing is done. Diagnosis is made through patient history; physical examination; lung function tests; blood tests; and chest x-ray or CT scan.

Treatment involves quitting smoking and avoiding exposure to other lung irritants; use of inhalers to ease symptoms; steroids; lung therapies; and getting influenza and pneumonia vaccines as recommended.

Bronchitis

Bronchitis is an inflammation of the bronchial tubes, the tiny airways in the lungs.

Acute bronchitis, or "chest cold," comes on suddenly and is caused by the same virus that causes the flu or the common cold. Chronic lasts at least three months and recurs over two years. It is caused by cigarette smoking and/or exposure to other pollutants.

Other risk factors are weakened immune system and gastric reflux (heartburn.)

Symptoms include cough with clear, greenish, or yellowish mucus; fatigue; mild headache; body aches; shortness of breath; low-grade fever; chest discomfort.

Acute bronchitis can lead to pneumonia. Chronic bronchitis is a form of chronic obstructive pulmonary disease (COPD) and requires medical treatment.

Diagnosis is made with chest x-ray and sputum test.

Acute bronchitis lasts 7 to 10 days and needs good supportive care – rest, fluids, and over-the-counter pain relievers. Antibiotics do not work against viral illness.

Chronic bronchitis is treated with lifestyle changes – especially smoking cessation – and an inhaler or other lung medication.

Flu shots, frequent handwashing, and not smoking are the best prevention.

Atypical chest pain

Atypical chest pain describes the situation when someone's chest pain is unlikely to be related to heart or lung disease. There are many other possible causes that could explain chest pain, like sore chest wall muscles or psychological factors like stress and anxiety.

It looks like your chest pain is atypical, however further testing might be needed. Therefore, you should schedule an appointment within two days with your primary care physician who can coordinate these further tests. These will likely include a stress EKG (electrocardiogram), which is a readout of the heart's electrical activity during exercise.

Aspiration pneumonia

Aspiration pneumonia occurs when food, saliva, liquids, or vomit is breathed into the lungs or airways leading to the lungs, causing an infection.

Going to your doctor is important, since diagnosing Aspiration Pneumonia requires a chest x-ray and a blood test. Given the possibility of the infection worsening, starting antibiotic treatment as soon as possible is really key.

Amyotrophic lateral sclerosis (ALS)

Amyotrophic lateral sclerosis is also called ALS or Lou Gehrig's Disease. It is a degenerative disease that destroys nerve cells, which eventually leads to loss of control over muscle function.

The cause of ALS is not known. It may be inherited and/or due to a chemical imbalance, faulty autoimmune response, or exposure to toxic environmental agents.

Symptoms include weakness; difficulty with speaking, swallowing, walking, or using the hands; and muscle cramps. The muscles of the arms, hands, legs, and feet are most involved at first. It does not affect the senses or a person's mental ability.

ALS is progressive, meaning it worsens over time. There is no cure, but supportive care can keep the patient comfortable and improve quality of life.

Diagnosis is made through several tests including blood tests; urine tests; MRI; electromyography (EMG) to measure muscle activity; nerve conduction studies; and sometimes muscle biopsy or spinal tap (lumbar puncture.)

Treatment involves medications to both slow the progression of the disease and ease the symptoms; respiratory therapy; physical therapy; occupational therapy; and psychological support.

Acid reflux disease (GERD)

Gastroesophageal reflux disease is also called GERD, acid reflux disease, and heartburn. It is caused by a weakening in the muscle at the end of esophagus. This allows stomach acid to flow backward, or reflux, up into the esophagus.

Risks factors for GERD include obesity, smoking, diabetes, hiatal hernia, and pregnancy.

Symptoms include a painful burning sensation in the chest and throat, and sometimes difficulty swallowing.

If heartburn occurs more than twice a week, a doctor should be consulted. If symptoms are accompanied by jaw or arm pain, and/or shortness of breath, these may be signs of a heart attack and constitute a medical emergency.

Repeated exposure to stomach acid damages the lining of the esophagus, causing bleeding, pain, and scar tissue.

Diagnosis is made by patient history and sometimes by x-ray, upper endoscopy, or other tests to measure refluxed acid.

Treatment begins with over-the-counter antacids and lifestyle changes. Medication may be used to reduce stomach acid, and surgery may be done to strengthen the sphincter muscle at the lower end of the esophagus.

Achalasia

Achalasia is a disorder of the esophagus, the tube that carries food from the mouth to the stomach. This condition affects the ability of the esophagus to move food into the stomach.

You should visit your primary care physician within the next 24 hours, where imaging and exploration of your swallowing issues can be fully worked up. With diagnosis, treatment is typically surgical and outcomes are good.

Rarity: Ultra rare

Top Symptoms: pain below the ribs, regurgitation, unintentional weight loss, heartburn, deep chest pain, behind the breast bone

Urgency: Primary care doctor

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Entry of food and liquids in the airways treatments and relief

As long as aspiration is not preventing normal breathing or occurring along with a fever, treatments and methods of prevention can begin at home.

At-home treatment

At-home remedies can be used to limit or prevent the occurrence of aspiration.

  • Positioning: Try sitting up straight while eating and limit distractions.
  • Portioned bites: Try taking smaller bites and sips of food and drink.
  • Slow down: Try to consume food at a slower pace.

When to see a doctor

You should consult your physician for the following, who may recommend further treatment:

  • Recurrent episodes of pneumonia
  • Repetitive actions: Such as onstantly clearing the throat, coughing, or feeling as though you are choking while eating
  • Severe and recurrent heartburn: Especially if there is also trouble swallowing
  • Physical therapy: You may be referred to a physical therapist who can help with swallowing difficulties.

When it is an emergency

You should seek treatment without delay if:

  • You or someone you are with is having extreme difficulty breathing: Especially with blue-tinged lips or severe distress
  • You or someone you are with is running a fever and is having painful, troubled breathing

FAQs about entry of food and liquids in the airways

How long does aspiration pneumonia take to develop?

Aspiration pneumonia is a pneumonia caused by inhalation of some substance, usually saliva or food and occassionally stomach contents. The bacteria from the mouth then reach the lungs and are allowed to grow if the immune system is compromised or a particularly large number of bacteria are allowed to reach the lung. Aspiration pneumonia can take up to a day or two to develop lung symptoms after the aspiration event.

Are choking and aspiration the same thing?

No. Choking is an inability to breathe because of blocking of the windpipe or larynx. Choking can cause unconsciousness and death within minutes. Aspiration is inhalation of something that is lodged in a portion of the lung or distal airway. It can compromise a portion of the lung but does not refer to blockage of an entire lung.

Can aspiration cause death?

Yes, aspiration — especially of caustic chemicals, including stomach acid, or smoke — can cause sufficient damage to the lung resulting in death. Additionally, reactions to aspirated substances can cause acute respiratory distress syndrome (ARDS) which can lead to inability of the lung to properly transfer inhaled oxygen into the blood through destruction of lung membrane.

What are the aspiration precautions?

For an individual with trouble swallowing, a medical professional may recommend a diet that has a thicker consistency, as thinner fluids carry higher risks of aspiration. An example would be patients who suffered a stroke that damaged their swallowing abilities or gag reflex. For individuals in areas with dangerous particles (e.g. firefighters in smoky rooms, healthcare professionals around tuberculous patients), a facial mask usually referred to as an N95 respirator may be used.

What is silent aspiration in infants?

For children who are developmentally delayed or who have repeated aspiration events, the cough or gag reflex may become diminished and coughing, choking, or gagging may be less evident or not evident at all. When a child shows no reflexive (coughing, gagging, sputtering) signs of aspiration, but is found to have aspirated, this is called silent aspiration.

Questions your doctor may ask about entry of food and liquids in the airways

  • Have you ever been diagnosed with Parkinson's disease?
  • Have you had any changes in your weight?
  • Do you have a cough?
  • Any fever today or during the last week?

Self-diagnose with our free Buoy Assistant if you answer yes on any of these questions.

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Dr. Rothschild has been a faculty member at Brigham and Women’s Hospital where he is an Associate Professor of Medicine at Harvard Medical School. He currently practices as a hospitalist at Newton Wellesley Hospital. In 1978, Dr. Rothschild received his MD at the Medical College of Wisconsin and trained in internal medicine followed by a fellowship in critical care medicine. He also received an MP...
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References

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  7. Dysphagia. National Stroke Association. National Stroke Association Link