What’s Going On When Something Goes Down the Wrong Pipe?

Understanding aspiration — from how it happens to when to see your doctor

What's Going On When Something Goes Down the Wrong Pipe?

You’re at the ballgame with friends, snacking on peanuts. The bases are loaded, and then, just like that, your favorite player hits a grand slam!

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You rise to your feet to cheer — but some of those peanut crumbles in your mouth catch in your throat. After a coughing fit, you finally feel some relief. But what the heck just happened?

Something got sucked into your breathing tube instead of entering your food tube as it should.

What’s going on when something goes down “the wrong pipe” like that? It’s what doctors call aspiration.

How does aspiration happen?

When foreign material — food, drink, stomach acid, or fumes — enters your windpipe (trachea), it’s known as aspiration.

Normally, a well-coordinated muscle interaction in your lower throat propels food into your food tube (esophagus) and protects your airways. Your vocal cords and epiglottis help keep your airways closed off from food, drink or saliva.

It’s an automatic process, but sometimes something slips through the wrong way, especially when you’re distracted.

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How does your body respond?

When you aspirate, your body’s fight-or-flight response triggers an outpouring of adrenaline and boosts your heart rate and blood pressure. A gag or cough reflex will start automatically and often fixes the problem, says Bohdan Pichurko, MD, Cleveland Clinic’s Pulmonary Function Lab Director.

“This is often brief if we promptly expel the aspirated material,” he says. “However, at the other extreme, it may follow eventually with fever and reduced oxygen levels, requiring medical attention for possible pneumonia.”

So how should you respond if your cough alone doesn’t do the trick?

  • Don’t panic.
  • Stop what you’re doing and lie on your belly with a cushion under your hips. This tilts your windpipe slightly downward, which can help expel the foreign material.

When to see a doctor

If you’re still coughing two to four hours after aspiration or if blood appears, call a doctor. Watch for fever, chills, and/or a cough that produces discolored mucus or sharp stabbing chest pain.

“Over 24 hours following aspiration, respiratory infection such as bronchitis or pneumonia may complicate the process,” Dr. Pichurko says. “When healthy, your bronchial tubes are sterile, delicate structures that don’t tolerate the intrusion of abnormal material.”

Repeated episodes of aspiration are sometimes a sign that you have another issue, he says.

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Frequent aspiration accompanied by hoarseness may signal a vocal cord disorder. In this case, consult a physician who specializes in the ears, nose and throat for an examination.

Regular coughing that occurs during meals or repeatedly awakens you from sleep may point to a swallowing disorder or muscle coordination issues.

“Talk to your primary physician and he or she will likely arrange an X-ray swallowing study,” Dr. Pichurko says. “In the elderly, this may occur as an early sign of a neurological disorder such as Parkinson’s disease or previous stroke, or in the setting of severe muscle weakness due to an underlying chronic illness.”

Prevention tips

A few tips can help you avoid aspiration:

  1. Don’t talk with your mouth full. Talking keeps your airways open while you swallow, when they should be closed and protected.
  1. Take your time when you eat. Divide your food into small portions, and chew each bite thoroughly. 
  1. Avoid heavy (fried and seasoned) foods at least three hours before bedtime. This helps keep your stomach from producing digestive juices that are more likely to prompt acid reflux and backwash into your esophagus, throat and lungs when you lie down.
  2. Take care of your teeth and gums. “With good oral hygiene, you can clear even the occasional aspiration quickly with no complicating infection from bacteria from your mouth or lasting damage to your bronchial tubes and lungs,” Dr. Pichurko says.

And if the batter smacks a home run at that baseball game? Make sure you swallow your peanuts before you start to cheer.

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