Describe the epidemiology.
80% of all cases occur in children < 3 years.
Peak incidence: 1–2 years
FBA accounts for 0.16–0.33% of adult bronchoscopies.
Incidence: rises with age
Mortality rate: highest in patients 80–90 years of age
Describe causes of children and infants.
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.
Describe causes in adults.
Underlying conditions that increase the risk of aspiration
Neurological illnesses causing dysphagia
Altered mental status
Describe the pathophysiology of aspiration of an FB.
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
Describe the localization.
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.