Airway foreign bodies in adults
- Wes Shepherd, MD, FCCP
Wes Shepherd, MD, FCCP
- Associate Professor of Medicine
- Virginia Commonwealth University Medical Center
- Section Editors
- Polly E Parsons, MD
Polly E Parsons, MD
- Editor-in-Chief — Pulmonary and Critical Care Medicine
- Section Editor — Critical Care
- Professor of Medicine
- University of Vermont College of Medicine
- Praveen N Mathur, MB;BS
Praveen N Mathur, MB;BS
- Section Editor — Interventional Pulmonology
- Professor of Clinical Medicine
- Indiana University School of Medicine
Foreign body aspiration (FBA) is a potentially life-threatening event. Flexible and rigid bronchoscopy have become the cornerstone of both the diagnosis and treatment of patients with suspected FBA. Although FBA was traditionally managed by otolaryngologists and thoracic surgeons, the evolution of smaller diameter flexible bronchoscopes has expanded the role for pulmonary physicians in the diagnosis and management of patients who present with FBA.
The evaluation and treatment of FBA in adults will be reviewed here. FBA in children, central airway obstruction, and technical aspects of rigid bronchoscopy are discussed separately. (See "Airway foreign bodies in children" and "Clinical presentation, diagnostic evaluation, and management of central airway obstruction in adults" and "Rigid bronchoscopy: Intubation techniques".)
Foreign body aspiration (FBA) is more common in children than in adults. Data from the National Security Council reported that approximately 80 percent of cases occur in patients younger than 15 years of age, with the remaining 20 percent presenting over the age of 15 years . Overall, death from FBA is the fourth leading cause of accidental home and community deaths in the United States (table 1) with over 4600 fatal episodes of FBA reported during 2009 .
Death from FBA peaks in children <1 years old and in adults >75 years [1-6]. For children under the age of four years, FBA is the fourth leading cause of accidental death with several large case series reporting a peak incidence at one to two years [3-6]. Comparatively, tracheobronchial FBA is rare in older children and young adults [1,2,7]. However, in adults over the age of 75 years, the incidence rises again with deaths from FBA peaking at age 85 years .
Several observational case series report low rates of FBA in adults (0.66 per 100,000) [9-15]. One retrospective study from a single center reported the removal of 89 foreign bodies in adults over a 20 year period . Similarly, case series from the Mayo Clinic identified 60 adults diagnosed with FBA over a 33-year period and studies from a single center in Taiwan reported 43 cases over a 15-year period [11,13].To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- Clinical manifestations
- Life-threatening asphyxiation
- Non-life-threatening foreign body
- Foreign body removal
- - Choice of procedure
- - Flexible bronchoscopy
- - Rigid bronchoscopy
- Anti-inflammatories and antibiotics
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS