What is an airway obstruction?
An airway obstruction is a blockage in any part of the airway. The airway is a complex system of tubes that conveys inhaled air from your nose and mouth into your lungs. An obstruction may partially or totally prevent air from getting into your lungs.
Some airway obstructions are minor, while others are life-threatening emergencies that require immediate medical attention.
The types of airway obstructions are classified based on where the obstruction occurs and how much it blocks:
- Upper airway obstructions occur in the area from your nose and lips to your larynx (voice box).
- Lower airway obstructions occur between your larynx and the narrow passageways of your lungs.
- Partial airway obstructions allow some air to pass. You can still breathe with a partial airway obstruction, but it’s difficult.
- Complete airway obstructions don’t allow any air to pass. You can’t breathe if you have a complete airway obstruction.
- Acute airway obstructions are blockages that occur quickly. Choking on a foreign object is an example of an acute airway obstruction.
- Chronic airway obstructions occur two ways: by blockages that take a long time to develop or by blockages that last for a long time.
The classic image of an airway obstruction is someone choking on a piece of food. But that’s only one of many things that can cause an airway obstruction. Other causes include:
- inhaling or swallowing a foreign object
- small object lodged in the nose or mouth
- allergic reaction
- trauma to the airway from an accident
- vocal cord problems
- breathing in a large amount of smoke from a fire
- viral infections
- bacterial infections
- respiratory illness that causes upper airway inflammation (croup)
- swelling of the tongue or epiglottis
- abscesses in the throat or tonsils
- collapse of the tracheal wall (tracheomalacia)
- chronic bronchitis
- cystic fibrosis
- chronic obstructive pulmonary disease (COPD)
Children have a higher risk of obstruction by foreign objects than adults. They’re more likely to stick toys and other small objects in their noses and mouths. They may also fail to chew food well before swallowing.
Other risk factors for airway obstruction include:
- severe allergies to insect stings such as those from bees or to foods such as peanuts
- birth defects or inherited diseases that can cause airway problems
- neuromuscular disorders and other conditions that cause people to have a difficult time swallowing food properly
The symptoms of an airway obstruction depend on the cause. They also depend on the location of the obstruction. Symptoms you may experience include:
- cyanosis (bluish-colored skin)
- difficulty breathing
- gasping for air
- high-pitched breathing noises such as wheezing
Airway obstructions are diagnosed by evaluating your signs and symptoms. Doctors look for signs that include:
- alterations in your normal breathing pattern, whether rapid or shallow breathing
- decreased breath sounds in your lungs
- high-pitched breath sounds in the upper airway or mouth
- no breathing
- bluish skin color
Certain tests may also be used to determine the cause of your airway obstruction. During an emergency, your doctor will likely order an X-ray first to determine the cause of your symptoms.
If an X-ray fails to determine the cause of the obstruction, your doctor may choose to order more advanced testing. This may include a bronchoscopy.
During this procedure, your doctor inserts an instrument called a bronchoscope through your mouth or nose to look into your lungs for any foreign bodies.
Bronchoscopy can also help your doctor evaluate different causes of obstruction. This includes tracheomalacia (weakness and collapse of the trachea).
It also includes infectious causes, such as mucous plugging in patients with chronic lung conditions like emphysema and cystic fibrosis.
Your doctor may also order a laryngoscopy. During this procedure, your doctor will examine your larynx with an instrument called a laryngoscope.
Additional tests may include a CT scan of the head, neck, or chest to determine other sources of obstruction, such as epiglottitis (an infection and inflammation of the epiglottis).
The epiglottis is the flap of tissue that protects and covers your trachea to prevent food and foreign bodies from entering.
An airway obstruction is usually an emergency situation. Call 911 if you see someone experiencing an airway obstruction.
There are some things you can do while you’re waiting for emergency services to arrive, including the following.
The Heimlich maneuver
This is an emergency technique that may help a person who is choking on a foreign object:
- The maneuver involves one person standing behind the person who is choking, wrapping their arms around the choking person’s waist.
- The person performing the maneuver then makes a fist with one hand and puts it slightly above the person’s belly button.
- They should then grab that fist with their other hand and press into the person’s abdomen with five quick thrusts.
- They should repeat these five abdominal thrusts until the object becomes dislodged or emergency services arrive.
Note: The Red Cross also recommends including five back blows, although some institutes, such as the American Heart Association, don’t teach this technique.
If following the Red Cross technique, repeat the cycle of five back blows and five abdominal thrusts until the object becomes dislodged or emergency services arrive.
Epinephrine can be used to treat airway swelling due to an allergic reaction.
People with severe allergies, such as those with allergies to food or bee stings, can develop sudden and rapid swelling of the throat and tongue. This can lead to near or complete airway obstruction within minutes.
People who have severe allergies usually carry EpiPens. These are simple injectors containing epinephrine. People who carry EpiPens are instructed to deliver one injection into the outer thigh as soon as they experience symptoms of a severe allergic reaction.
An epinephrine injector can help a person experiencing anaphylactic shock while they are waiting for medical services to arrive. Medical professionals should always evaluate people who receive epinephrine injections as soon as possible.
Cardiopulmonary resuscitation (CPR)
CPR is used when a person is unable to breathe and has lost consciousness. It keeps oxygenated blood flowing to the brain until emergency services arrive.
To perform CPR:
- Place the heel of your hand in the center of their chest.
- Place your other hand on top, and use your upper body weight to push straight down on the chest.
- You should do this about 100 times in a minute until an ambulance arrives.
Once an ambulance has arrived, there are several different ways airway obstruction can be treated based on what caused it.
An endotracheal or nasotracheal tube may be inserted into the airway. This can help get oxygen through swollen airways. A tracheostomy and cricothyrotomy are surgical openings made in the airway to bypass an obstruction.
These procedures should be performed by highly trained medical professionals and are generally required when all of the above interventions have failed.
With prompt treatment, an airway obstruction can often be treated successfully. However, airway obstructions are extremely dangerous. They can be fatal even with treatment.
If you or someone you know may have an airway obstruction, get help immediately.
Many types of airway obstructions can be prevented. Reduce your risk by doing the following:
- Avoid drinking a lot of alcohol before eating.
- Eat small bites of food.
- Eat slowly.
- Supervise small children when eating.
- Chew thoroughly before swallowing.
- Make sure your dentures fit properly.
- Keep small objects away from children.
- Don’t smoke.
- Visit your doctor regularly if you have a condition that can cause a chronic airway obstruction.