Management of Airway Foreign Bodies in Pediatric and Adult Populations

Airway foreign body aspiration represents a critical emergency across age groups, with distinct challenges in children and adults. In infants and toddlers, organic materials such as nuts and seeds predominate, often precipitating sudden choking episodes and rapid onset respiratory distress. Delayed or missed diagnosis may lead to complications including pneumonia, bronchiectasis and airway obstruction. In older children and adults, aspirated objects range from dental prostheses and food debris to small metallic items, with presentation often masked by nonspecific cough or haemoptysis. Diagnosis combines clinical history, physical examination and imaging—radiography and computed tomography—guided by a high index of suspicion. Therapeutic removal relies on endoscopic techniques: rigid bronchoscopy remains the gold standard in children given superior airway control, while flexible fibreoptic bronchoscopy offers a minimally invasive option in adults and as an adjunct in paediatric cases. In refractory or complicated scenarios, surgical approaches such as thoracotomy or bronchotomy may be required. Prevention strategies include caregiver education, supervised feeding and public awareness of first-aid manoeuvres. Multidisciplinary coordination among emergency physicians, pulmonologists, anaesthetists and surgeons is essential to optimise outcomes and minimise morbidity and mortality.

Research from Nature Portfolio

Recent studies have characterised aspiration in the elderly, revealing atypical presentations and diagnostic delays. In a cohort of patients aged 65 and over, fewer than one third recalled an aspiration event, and over a quarter experienced symptom duration exceeding one month. Computed tomography often demonstrated abnormal density shadows and infiltrates, while bronchoscopy found purulent secretions in more than half of cases and granulation tissue nearly half the time. Food items—most commonly bone fragments, dentures and tablets—constituted the majority of foreign bodies, with a right-sided predilection. Bronchoscopic extraction achieved a high success rate of close to 97%, though up to 7% of patients required multiple interventions or rigid instruments. This work underscores the need for vigilant assessment in older adults and reinforces bronchoscopy as the primary modality for safe, effective extraction.

Management of Airway Foreign Bodies in Pediatric and Adult Populations publication trend

The graph below shows the total number of articles in management of airway foreign bodies in pediatric and adult populations across all publications each year (not limited to Nature Index journals).

Technical terms

Bronchoscopy: Endoscopic examination and intervention in the trachea and bronchi, performed with rigid or flexible instruments to visualise and remove intraluminal foreign material.

Age-standardized incidence rate (ASIR) and death rate (ASDR): Epidemiological measures that adjust rates of events (aspirations or fatalities) to a standard age distribution, enabling comparisons across populations and time periods.

Ultralow-dose computed tomography (CT): A CT imaging technique employing minimal radiation exposure while preserving diagnostic accuracy, particularly useful in paediatric airway assessment.

References

1. Clinical characteristics and removal approaches of tracheal and bronchial foreign bodies in elders. Scientific Reports (2024).
2. The global, regional, and national burden of foreign bodies from 1990 to 2019: a systematic analysis of the global burden of disease study 2019. BMC Public Health (2024).
3. Diagnosis of foreign body aspiration with ultralow-dose CT using a tin filter: a comparison study. Emergency Radiology (2020).
4. Application of flexible fiberoptic bronchoscopy in the removal of adult airway foreign bodies. BMC Surgery (2020).