Yes, it is possible for food to accidentally enter the lungs. This can occur when food “goes down the wrong pipe” and gets inhaled into the trachea (windpipe) instead of being swallowed into the esophagus.
How does food enter the lungs?
Normally when we eat, the food is chewed and formed into a bolus that travels down the pharynx (throat) and enters the esophagus, which connects to the stomach. The epiglottis, which is a flap of tissue that covers the entrance to the trachea (windpipe), closes during swallowing to prevent food from entering the airway.
However, sometimes the epiglottis does not close properly and food can be aspirated (inhaled) into the trachea. This may occur if someone laughs or talks while eating, takes too big of a bite, eats too quickly, has swallowing difficulties, or has impaired sensation in the back of the throat.
When food enters the trachea instead of the esophagus, it is called aspiration. The food particles can reach the smaller airways of the lungs, causing choking, coughing, and pulmonary complications.
What types of foods commonly cause aspiration?
Foods that are slippery, loose, or stringy tend to be more likely to cause aspiration. Examples include:
- Liquids like water, milk, juice
- Smoothies, shakes
- Soft, pureed foods like applesauce, mashed potatoes
- Loose mixed consistency foods like cereal with milk
- Stringy foods like meat, cheese, fruits/veggies
- Oily or greasy foods
- Crunchy foods that can break into small particles like chips, nuts, popcorn
People with swallowing disorders like dysphagia are at higher risk for aspiration with thin liquids. Thickened liquids are often recommended to make swallowing safer.
What happens when food enters the lungs?
When food accidentally enters the lungs, it can cause:
- Choking or coughing – The foreign material irritates the sensitive tissues of the trachea and bronchi, triggering coughing and choking as the body tries to expel the food particles.
- Infection – Food can introduce bacteria into the lungs, leading to aspiration pneumonia or lung abscesses.
- Inflammation – Food particles can cause inflammatory responses like pneumonia, bronchitis, or scarring of lung tissue.
- Asphyxiation – Very large food particles can completely block airflow, preventing oxygen from reaching the lungs and brain.
- Other complications – Such as asthma exacerbations, respiratory failure, pulmonary fibrosis, atelectasis (collapsed alveoli), and acute respiratory distress syndrome (ARDS).
Signs of aspiration include coughing/choking during swallowing, wheezing, increased difficulty breathing, and symptoms of pneumonia after eating. Anyone experiencing suspected aspiration should seek immediate medical care.
Who is at risk for aspiration?
Certain groups have an increased risk of experiencing aspiration of food into the lungs:
- Older adults – Swallowing ability can decline with age.
- People with swallowing disorders like dysphagia
- Those with neuromuscular conditions such as stroke, MS, ALS, Parkinson’s
- Individuals with developmental disabilities or syndromes
- People with structural problems like cleft palate or laryngomalacia
- Those with tracheostomies or ventilator dependence
- People with gastroesophageal reflux disease (GERD)
- Those taking medications that can impair swallowing like sedatives
- People who have had radiation therapy to the head, neck or esophagus
- Individuals with cognitive impairments such as dementia or intoxication
- Anyone with impaired cough or gag reflexes
How is aspiration diagnosed?
If aspiration is suspected, a physician may use some of the following tests to evaluate swallowing function and confirm the diagnosis:
- Videofluoroscopic swallow study (VFSS) – This is the gold standard test, which uses x-ray video to visualize the swallowing mechanism and identify issues.
- Fiberoptic endoscopic evaluation of swallowing (FEES) – A small endoscope is inserted through the nose to view swallowing in real-time.
- Modified barium swallow study – Patients swallow foods and liquids mixed with barium contrast to observe swallowing function.
- Pulse oximetry – This monitors oxygen saturation levels before and after swallowing as a screen for aspiration.
- Chest x-ray – Can identify aspiration pneumonia or abnormalities in the lungs.
- Cough reflex testing – Assesses the function of cough reflexes.
Other indicators of possible aspiration include coughing or choking during meals, gurgly or wet-sounding voice after eating, recurrent pneumonia, and mealtime fatigue or avoidance of food.
How can aspiration be prevented?
Here are some tips to help prevent food from accidentally entering the airway:
- Chew food thoroughly and take small bites.
- Avoid talking, laughing, or rushing while eating.
- Sit upright while eating and remain upright for 30+ minutes after.
- Keep distractions to a minimum during meals.
- If needed, slightly tilt the head forward when swallowing.
- Consider thickening liquids to make them easier to control.
- Try chin tuck technique: tucking chin down towards chest when swallowing.
- Eat slowly and pause between bites.
- Limit intake of slippery or stringy foods if aspiration risk.
- Perform swallowing exercises if recommended.
- Use fatigue management strategies during meals.
- Consider adaptive devices like special cups or utensils if helpful.
For those with dysphagia or high aspiration risk, following the recommendations of a speech therapist or swallowing specialist is key.
How is aspiration treated?
Treatment depends on the severity of the aspiration event but may involve:
- Clearing the airway – Using rescue breathing, abdominal thrusts, or suctioning to remove blockages.
- Oxygen – Administering oxygen support if oxygen levels are low or patient is distressed.
- Medications – Such as antibiotics for pneumonia, bronchodilators for asthma or wheezing, steroids to reduce inflammation.
- Swallowing therapy – With a speech therapist to improve safety and coordination of swallowing function through exercises and strategies.
- Diet modification – Changing food textures and liquids to easier to swallow consistencies.
- Tube feeding – Using a nasogastric or gastrostomy tube to deliver nutrition if oral feeding is deemed unsafe.
- Surgery – In some cases surgery may be recommended to remove obstructions or improve anatomy.
Preventing further aspiration is a key goal of treatment. Individuals with aspiration issues often need help from a multidisciplinary team including speech pathology, respiratory therapy, nutrition services, and sometimes surgery.
What is silent aspiration?
Silent aspiration refers to aspiration that occurs without any outward signs of coughing or choking. It happens when food or liquids enter the airway but do not trigger the normal cough reflex.
Causes of silent aspiration include:
- Dulled or absent cough/gag reflex
- Neurological conditions impairing reflexes like stroke or Parkinson’s
- Very small amounts of aspiration not large enough to trigger coughing
- Aspiration happening below the vocal cords in the lower airways
Silent aspiration often goes undetected but can still lead to aspiration pneumonia and lung damage over time. Special testing like VFSS is often needed to diagnose it.
What food textures are safest for people with swallowing problems?
The safest food textures for individuals with dysphagia or swallowing disorders depend on the specifics of their condition, but some general guidelines include:
- Pureed foods – Smooth, pudding-like consistency is often easiest to swallow and least likely to aspirate.
- Mechanical soft foods – Well-cooked vegetables or fruits mashed with a fork, moist shredded meats.
- Thick liquids – Thin liquids thickened to a nectar or honey consistency flow more slowly and are more controllable.
- Avoid mixed consistencies – Foods that combine thin liquid and solid pieces can be risky.
- Avoid hard, dry, or crunchy foods – Items that can break into small particles or scratch the throat.
Following recommendations from a speech language pathologist or registered dietician trained in dysphagia can help identify the optimal diet textures for safe, adequate nutrition.
Conclusion
Aspiration of food into the airway is a serious medical issue that requires prompt evaluation and treatment. Proper swallowing function involves coordination of multiple anatomical structures and neurological components. Dysfunction in any part of this system can increase aspiration risk.
Prevention is key, especially for high-risk individuals. Steps like proper eating habits, swallowing therapy, and diet modifications can help reduce the likelihood of food accidentally entering the lungs. However, anyone experiencing signs of aspiration requires immediate medical assessment to check for complications and guide appropriate intervention.