Foreign body aspiration into the airway, is a condition that poses a direct threat to human health and life. In fact, it is the cause of respiratory failure and is the reason for many emergency room admissions to hospital wards, especially in children under 3 years of age. In the group of children aged between 1 and 3 years, there are up to 3,000 deaths per year in America caused by the presence of a foreign body in the airway, of which approximately 7% are sudden deaths. [1]

Who is affected?

According to epidemiological data, foreign body in the larynx and airway is a very common childhood problem. Among all patients, in those under 12 years of age, up to 85% are treated, precisely because a foreign body has been aspirated into the airways. The places where foreign bodies of various kinds, both organic and inorganic, are most frequently located are the trachea and the larynx. Unfortunately, this is a problem that not only can lead to irreversible changes, but there is also the possibility that failure to provide appropriate assistance can result in death.

Children versus adults

A very important consideration when a foreign body is present in the airway is the age of the patient. This is due to the anatomical differences that are observed at different ages and stages of development. Organs such as the larynx, trachea and epiglottis differ in shape, size, length and other age-specific parameters. The situation is similar with regard to the workings of the respiratory system, whose rhythm and mechanical action, are also somewhat different between children and adults. [2]

Symptoms

A patient who arrives in the emergency room should have a detailed physical examination, preceded by an equally detailed history, which is often crucial in making a correct diagnosis and providing prompt assistance. If the patient is a child, it is essential to question the parents carefully about the circumstances and timing of the onset of the worrying symptoms.

The main effects produced by the presence of a foreign body in the airway include the sudden appearance of cyanosis, coughing or distressing wheezes that emerge from the airway during breathing.

The symptoms that appear vary mainly due to the size of the foreign body that is in the airways. Thus, there may be a dry cough as a reaction and an attempt to remove the lingering blockage, a localised increase in air resistance caused by the blockage, localised or widespread wheezing and breathing difficulties.

photo: panthermedia

Diagnostic process

Specialists stress the importance of the patient's history in the diagnosis of a foreign body in the airway. It is so important because, in up to 40 per cent of cases, the physical examination does not reveal signs of foreign body aspiration into the airways.

The physical examination is therefore another diagnostic step to confirm the assumptions made by the doctor during the history.

If both stages confirm the presumption of a foreign body in the airway, an imaging examination is necessary to determine the exact location of the obstruction causing the breathing difficulties. X-ray examination should be performed in both the anteroposterior and lateral planes and, if necessary, also on inspiration and expiration.

The image obtained from the X-ray depends on the type of foreign body that is lodged in the airway and on its shadowing properties, which is extremely important for its localisation. In addition, the length of time the foreign body remains in the airway is also important because of the effects it has. In the case of short retention times, ventilatory emphysema develops, whereas after a long period of retention, inflammatory reactions and atelectasis are observed.