If you inhale something instead of swallowing it or if stomach contents back up and enter your airway, you experience aspiration. Some people may experience complications, including infections.
Aspiration means inhaling some kind of foreign object or substance into your airway. Usually, it’s food, saliva, or stomach contents that make their way into your lungs when you swallow, vomit, or experience heartburn.
Sometimes aspiration won’t cause symptoms. This is called “silent aspiration.” You may experience a sudden cough as your lungs try to clear out the substance. Some people may wheeze, have trouble breathing, or have a hoarse voice after they eat, drink, vomit, or experience heartburn. You may have chronic aspiration if this occurs frequently.
Many times, aspiration doesn’t cause complications. Sometimes, however, it can lead to serious problems such as aspiration pneumonia, which is a lung infection. If you suspect aspiration in yourself or someone you care for, you should see your doctor.
Read on to learn what increases your risk for aspiration, complications, treatment, and more.
Some people refer to a case of aspiration as food “going down the wrong way.” This can happen due to reduced tongue control, poor swallowing reflexes, or medical devices that assist with breathing.
The average person can usually cough out a foreign object before it enters the lungs.
Most often, aspiration is due to one of the
|Neuromuscular causes||Some neurological conditions, such as Parkinson’s disease or advanced dementia, can cause reduced tongue control and abnormal swallow reflexes. Neurological disorders like stroke, brain injury, and intracranial tumors can also cause reduced tongue control and swallowing issues.|
|Esophageal disorders||These conditions affect the throat and swallowing abilities. They include gastroesophageal reflux disease (GERD), dysphagia, and throat cancer.|
|Throat surgery||People who’ve had surgery or a condition that affects their larynx may have trouble swallowing. If the larynx doesn’t close tightly, food or liquids can enter the windpipe.|
|Dental problems||This can interfere with chewing or swallowing reflexes|
|Medical device in airway||People with a nasogastric tube, surgical opening in the windpipe (tracheostomy), feeding tube, or who’ve had procedures to examine the digestive tract, are also at high risk for aspiration.|
Aspiration during surgery
While you’re under general anesthesia or sedation, contents from your stomach may move up to your mouth and enter your trachea and lungs.
Surgical teams are prepared for these moments, but this is why it’s important to fast before surgery. Drooling after surgery might be a sign of aspiration.
A 2019 study out of Australia and New Zealand found that emergency procedures and the patient being over the age of 80 are two of the biggest risk factors for aspiration during surgery.
People with health problems that affect swallowing are at a higher risk of aspirating. These health conditions
- impaired consciousness
- lung disease
- dental problems
- swallowing dysfunction
- impaired mental status
- certain neurologic diseases
- radiation therapy to the head and neck
Aspiration in older adults
Older adults are also more likely to have a condition known as dysphagia, which is difficulty swallowing. It’s common among stroke patients and adults with dementia, Parkinson’s disease, GERD, multiple sclerosis, and other neuromuscular conditions. Aspiration is one symptom of dysphagia.
Older adults who need a feeding tube are also at higher risk of aspiration.
Symptoms of aspiration usually appear after eating, drinking, vomiting, or an episode of heartburn.
Silent aspiration usually has no symptoms, and people aren’t always aware that fluids or stomach contents have entered their lungs. Overt aspiration will usually cause sudden, noticeable symptoms such as coughing, wheezing, or a hoarse voice.
Silent aspiration can occur in people with sensory differences or who are under institutional care. In these cases, drooling or changes in the sound of their breathing and talking may be clues of swallowing difficulties.
Make an appointment with the doctor if you or someone you know experiences these symptoms after eating, drinking, vomiting, or an episode of heartburn, especially if they:
- have a neurological condition
- recently had throat surgery
- have throat cancer
- have problems with chewing or swallowing
- have a fever
- have difficulty breathing
If you notice someone choking or having trouble breathing, it’s important to call 911 and seek emergency help immediately.
You should make an appointment to see a doctor if you have repeated symptoms that reflect difficulty swallowing, like:
- pain while swallowing
- coughing up food
- feeling like something is stuck in your throat
- a fever higher than 100.4°F (38°C) degrees
You should also call your doctor if you frequently aspirate or regularly experience any of the following:
- chronic chest congestion
- wet cough
- shortness of breath
- tiredness while eating
- taking extra steps to clear your throat
- coughing, choking, or gasping for air upon waking up
Symptoms don’t always occur right away. They may develop after periods of aspiration and may turn into serious complications such as lung scarring or aspiration pneumonia.
Your doctor will ask if you’ve experienced any symptoms of aspiration, including after eating. If there are no symptoms, they may do a modified barium swallow test, which looks at your esophagus.
During a barium swallow test, your doctor will ask you to swallow a liquid that shows up on the X-ray to help them determine whether you have any underlying swallowing disorders.
Your doctor may also ask about other potential symptoms such as fever or chest pain to look for signs of pneumonia or pulmonary edema. They’ll also check for any problems with swallowing or underlying conditions such as GERD.
If they suspect aspiration has developed into another complication, they’ll order tests to see if there’s food or fluid in the lungs. These may include:
Treatment for aspiration depends on the cause.
For less severe cases, treatment may involve taking steps to stop aspiration from happening again. For some people, this may include:
- using straws
- eating small bites
- keeping proper posture while eating
- eating slowly
Some people may also benefit from dysphagia therapy, which focuses on techniques to swallow safely and efficiently.
If someone has aspiration pneumonia, they may
Severe cases may require surgery.
Aspiration increases your risk for
A similar process can occur with aspiration pneumonitis (which is the inhalation of sterile gastric contents). These two conditions can be difficult to differentiate.
In most cases, you won’t know you’ve developed pneumonia or pulmonary edema until you experience other symptoms such as difficulty breathing, coughing with mucus, or you receive a clinical diagnosis.
Symptoms of aspiration may appear differently in children or infants. They may appear as:
- problems feeding
- coughing while drinking
- arched back while feeding
- redness around the eyes during feeding or after
- frequent breathing issues
- slowed growth
Conditions that increase the risk of aspiration in children and infants are also those that contribute to swallowing disorders. They include:
- cleft palate
- delayed growth because of premature birth
- Down syndrome
- cerebral palsy or neuromuscular diseases, such as spinal muscular atrophy
Treatment and outlook
Aspiration in children may get better over time, depending on the cause. Treating the cause will often improve aspiration. You can also help to minimize your child’s risk by:
- making sure they have correct posture during feeding time
- thickening liquids as recommended by your speech therapist or physician
- practicing swallowing exercises with them
- changing the type of food so it’s easier to swallow
- avoiding giving a bottle to a baby who is lying down
In severe and high risk cases, your child may need a feeding tube to ensure they get enough nutrition until their condition improves.
Talk with your doctor if you think your child has problems with aspiration. It’s important to check that aspiration hasn’t developed into a complication.
- Rest before your start your meals.
- Take small bites or cut food into smaller pieces.
- Swallow completely before drinking.
- Sit upright when you eat.
- Choose food types that are easier for you to chew and swallow.
- Practice chewing and swallowing techniques, if provided.
- Visit your dentist on a regular basis.
- Avoid using sedative medications or medications that dry up your saliva before eating.
Anyone can aspirate. Most people tend to cough up the content they’ve inhaled. But people with an underlying condition are at a higher risk for aspiration developing into something more serious.
The outlook for aspiration depends on the cause. For many people, swallowing therapy and eating techniques — such as softening, chopping, or pureeing solid foods — can help prevent aspiration.