Bronchial Foreign Body: An overview

Introduction:

Lungs are a part of the breathing system in humans. They are responsible for transferring oxygen to the body. Through inhaling and exhaling, the oxygen reaches the lungs and is transported to all the body parts. Bronchi are thin tubes attached to the throat and lungs that act as a passage for air to come in and go out. When the bronchi get obstructed due to a foreign body or object, it may result in severe conditions and even death. Small children tend to put everything in their mouths. Small toys, balls, and coins are a few such objects that children aspirate. These objects go into the airways or bronchi and get stuck, resulting in difficulty breathing, choking, and other symptoms. Therefore, it is important to immediately treat the condition with emergency surgery to avoid further complications.

What Does a Bronchial Foreign Body Mean?

It is the foreign body aspiration or inhalation by small children under the age of two years. Any object or a foreign body inhaled by the child goes into the airways, trachea, or bronchi and gets stuck there.

What Is the Epidemiology of Foreign Body Aspiration?

It most commonly occurs in children less than two years of age. However, males and older adults are at more risk of foreign body aspiration than females. It is commonly seen in preschool children because of an incomplete dentition or teeth development. Small children do not have molars, so they cannot chew food properly and, as a result, swallow big chunks of food without chewing. They also have a natural tendency to explore external objects with their mouth by putting them into the mouth. This tendency also increases the risk of aspiration.

Which Foreign Bodies Are Commonly Aspirated or Inhaled?

• Most commonly, food items such as peanuts are aspirated.

• Hotdogs.

• Candies.

• Round-shaped objects such as marble balls, rubber balls, and grapes.

What Is the Pathophysiology of Foreign Body Aspiration?

After swallowing any foreign object, the airway becomes obstructed and leads to choking immediately. Sometimes, the foreign body gets impacted in the tracheobronchial tree (part of the breathing system where the trachea and bronchi transport the air to the lungs) or may get impacted anywhere between the larynx and bronchi. More commonly, the impaction occurs in the right bronchi and results in complete or partial obstruction of the bronchus leading to infection. In addition, a partial obstruction may result in inflammation of the surrounding tissues, wheezing, and coughing.

What Are the Symptoms of Foreign Body Aspiration?

• Choking is the most common symptom that occurs immediately after aspiration.

• Coughing.

• Wheezing sound with breathing.

• Shortness of breath or dyspnea.

How to Diagnose Foreign Body Aspiration?

1. Patient’s History - The patient may come to the doctor with acute symptoms such as choking and drooling or chronic (long-standing) obstruction without other symptoms. The patient may have had a history of chest pain and discomfort for several weeks. It is essential to take a complete history of the event.

2. Physical Examination - The doctor may hear a wheezing sound upon auscultation (listening to sounds through the stethoscope).

3. Bronchoscopy - It is a method to see the internal organs and structures through a bronchoscope (thin tube with a camera and light). It is inserted into the patient's airway through the mouth, and the internal structures are viewed on a monitor or screen.

4. Imaging Tests - X-rays of the chest may show expansion on one side and a flat diaphragm indicative of obstruction.

How Is Foreign Body Aspiration Treated?

Foreign Body Removal - Extraction or removal of the foreign body must be first done with forceps.

Emergency Surgery - It is generally performed when the patient has come to the doctor with acute aspiration or inhalation of a foreign body and choking. The patient must be taken to the operating room immediately. Generally, cricothyrotomy is indicated. It is a surgery in which the airway is maintained in patients who cannot breathe or have obstruction. In this surgery:

1. General anesthesia is given to the patient.

2. An incision is made on the throat of the patient.

3. A tube is inserted through the incision to maintain the airway and ventilation.

Rigid Bronchoscopy - After maintaining the airway, rigid bronchoscopy is the ultimate treatment. In this surgery:

1. It is a surgical procedure for the thoracic or chest region.

2. General anesthesia is given to the patient.

3. The bronchoscope or tube is inserted into the mouth of the patient.

4. The tongue is retracted, and the tube is pushed inwards to reach the epiglottis.

5. The tube is rotated at 90 degrees.

6. A telescope is inserted into the tube to visualize and identify the foreign object.

7. Other instruments are inserted through the tube, and the object is retracted.

What Are the Complications of Foreign Body Aspiration?

The complications of foreign body aspiration are:

• Injury to the brain.

• Damage to the bronchioles.

• Narrowing of the airways.

• Low oxygen levels in the blood.

• Abscess or infection in the lungs or airway. It generally occurs due to stuck food or bolus, which swells with time and gets infected.

• Death.

What Is the Differential Diagnosis of Foreign Body Aspiration?

Sometimes, the bronchial foreign body aspiration is confused with the following conditions:

• Stridor - A symptom of airway disorder in which a whistling sound is heard while breathing.

• Asthma - Narrowing and swelling of airways that cause difficulty breathing.

• Upper Respiratory Tract Infection - Viral infection commonly occurs in the nose, throat, and airways. Rhinovirus is a common virus that causes infection.

• Thickening of the Bronchi - It is called bronchiectasis, in which the tubes that carry air in and out of the lungs (bronchi) become thick.

Which Doctor Is Best to Treat Foreign Body Aspiration?

If the child is suspected of swallowing or inhaling any foreign body object, it is best to go to the emergency department and consult a pulmonologist immediately. Otolaryngologists and cardiothoracic surgeons are also helpful, depending on the location of the foreign body.

What Is the Success Rate of Foreign Body Aspiration Removal?

The prognosis is good if the foreign body is removed immediately or as early as possible. However, a delay in the treatment will lead to an increased risk of complications.

How to Prevent Children From Aspiring Foreign Objects?

• Keep small objects away from children, such as marble balls, coins, and so on.

• Teach the child not to put anything in their mouth.

• Do not feed small children, generally less than three years of age, with peanuts, grapes, and others.

• Teach the child to chew food properly before swallowing.

Conclusion:

Foreign objects such as small toys, round objects, or balls can cause severe and life-threatening conditions in small children. Because children naturally tend to put things into their mouths, the tiny objects quickly get into their airways. Upon aspiration, these foreign bodies obstruct the airways. As a result, choking is the most common symptom. However, sometimes, the child is asymptomatic, and the foreign body remains for a long time in the airways. Rigid bronchoscopy is the definitive treatment for this condition.