Overview

• Pediatric

  • 80% of all cases occur in children < 3 years.

  • Peak incidence: 1–2 years

• Adult

  • FBA accounts for 0.16–0.33% of adult bronchoscopies.

  • Incidence: rises with age

  • Mortality rate: highest in patients 80–90 years of age

• Aspiration of a FB (e.g., of nuts, raisins, coins, toys) while chewing

• The risk of aspiration is higher if the infant or child is speaking, laughing, or playing while chewing.

• Toddlers are prone to examining objects with their mouth, and a sudden inspiration can result in aspiration.

• Accidental aspiration

• Underlying conditions that increase the risk of aspiration

  • Neurological illnesses causing dysphagia

  • Intoxication

  • Altered mental status

  • Neuromuscular disease

Aspiration of an FB → airway obstruction

• Complete airway obstruction → collapse of the respiratory structures distal to the obstruction (e.g., atelectasis)

• Partial airway obstruction: formation of a ball-valve obstruction with air trapping → build-up of pressure distal to the obstruction

• Upper airway obstruction: a minority of FB are lodged in the larynx or trachea

• Bronchi: the right main bronchus is more often affected than the left main bronchus

  • Aspirated particles are most likely to become lodged at the junction of the right inferior and right middle bronchi → right lower and middle lobe aspiration pneumonia

  • Upper right lobe affected in bedridden patients, particularly while lying on their right side.

  • In children, the two main bronchi are affected with similar frequency (compared to adults); however, there is still a slight right-sided predominance.

  • Less severe than upper airway obstructions

Approximately 60% of foreign bodies become lodged in the right main bronchus because of its more vertical orientation compared to the left main bronchus.