eMedicine Specialties > Pediatrics: General Medicine > Pulmonology

Airway Foreign Body: Treatment & Medication

Author: Michael R Bye, MD, Professor of Clinical Pediatrics, Division of Pulmonary Medicine, Columbia University College of Physicians and Surgeons; Attending Physician, Pediatric Pulmonary Medicine, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University Medical Center
Contributor Information and Disclosures

Updated: May 21, 2009

Treatment

Medical Care

  • Bronchodilators and corticosteroids should not be used to remove the foreign body, and chest physical therapy and postural drainage may dislodge the material to an area where it may cause more harm, such as at the level of the vocal cords.
  • Medications are not necessary before removal, although the endoscopist may observe enough focal swelling after the material is removed to recommend a short course of systemic corticosteroids.
  • Unless the airway secretions are infected with organisms present, antibiotics are not necessary.

Surgical Care

  • Surgical therapy for an airway foreign body involves endoscopic removal, usually with a rigid bronchoscope.

Consultations

  • If the diagnosis is in question or a flexible bronchoscopy is needed, a pediatric pulmonologist should be consulted.
  • A pediatric surgeon or pediatric otolaryngologist usually performs the rigid bronchoscopy if necessary.

Medication

No medications are needed. If significant swelling is observed in the airway or if granulation tissue is present, a corticosteroid (eg, prednisolone, prednisone) may be administered. Unless airway secretions are infected, antibiotics are not helpful or necessary.

Corticosteroids

These agents elicit anti-inflammatory and immunosuppressive properties and cause profound and varied metabolic effects. They modify the body's immune response to diverse stimuli. If swelling in the airway or granulation tissue is present, a corticosteroid may help.


Prednisolone (Pediapred, Orapred, Prelone) or prednisone (Deltasone)

May decrease inflammation by reversing increased capillary permeability and suppressing PMN activity. Both are available in tab and syr formulations. For children who require a liquid formulation, prednisolone syr is more palatable than prednisone syr.

Adult

5-60 mg/d PO qd or divided bid/qid

Pediatric

2 mg/kg/d PO divided bid for 7 d
If used for <10 d, a taper is probably not necessary; otherwise, a tapering schedule should be used

Barbiturates, phenytoin, and rifampin may decrease prednisone effectiveness; monitor for hypokalemia with coadministration of diuretics

Documented hypersensitivity; active varicella or herpes infection (relative contraindications, address risks and benefits); GI bleeding

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Lower the dose as quickly as possible to reduce adverse effects and complications; prolonged use might be advisable on an alternate-day schedule; administer with meals to decrease GI upset; use with caution in patients with diabetes mellitus because more insulin may be necessary during therapy; prolonged use may be risky; abrupt discontinuation of glucocorticoids may cause adrenal crisis

More on Airway Foreign Body

Overview: Airway Foreign Body
Differential Diagnoses & Workup: Airway Foreign Body
Treatment & Medication: Airway Foreign Body
Follow-up: Airway Foreign Body
Multimedia: Airway Foreign Body
References
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References

  1. Pak MW, van Hasselt CA. Foreign bodies in children's airways: a challenge to clinicians and regulators. Hong Kong Med J. Feb 2009;15(1):4-5. [Medline].

  2. Eren S, Balci AE, Dikici B, et al. Foreign body aspiration in children: experience of 1160 cases. Ann Trop Paediatr. Mar 2003;23(1):31-7. [Medline].

  3. CDC. Nonfatal choking-related episodes among children--United States, 2001. MMWR Morb Mortal Wkly Rep. Oct 25 2002;51(42):945-8. [Medline].

  4. Bittencourt PF, Camargos PA, Scheinmann P, de Blic J. Foreign body aspiration: clinical, radiological findings and factors associated with its late removal. Int J Pediatr Otorhinolaryngol. May 2006;70(5):879-84. [Medline].

  5. National Safety Council. Accident Facts. 1992:32.

  6. [Guideline] American Association for Respiratory Care (AARC). Bronchoscopy assisting--2007 revision & update. Respir Care. Jan 2007;52(1):74-80.

  7. Ramirez-Figueroa JL, Gochicoa-Rangel LG, Ramirez-San Juan DH, Vargas MH. Foreign body removal by flexible fiberoptic bronchoscopy in infants and children. Pediatr Pulmonol. Nov 2005;40(5):392-7. [Medline].

  8. Zaupa P, Saxena AK, Barounig A, Hollwarth ME. Management strategies in foreign-body aspiration. Indian J Pediatr. Feb 2009;76(2):157-61. [Medline].

  9. Chung MK, Jeong HS, Ahn KM, et al. Pulmonary recovery after rigid bronchoscopic retrieval of airway foreign body. Laryngoscope. Feb 2007;117(2):303-7. [Medline].

  10. Bloom DC, Christenson TE, Manning SC, et al. Plastic laryngeal foreign bodies in children: a diagnostic challenge. Int J Pediatr Otorhinolaryngol. May 2005;69(5):657-62. [Medline].

  11. Kim IG, Brummitt WM, Humphry A. Foreign body in the airway: a review of 202 cases. Laryngoscope. Mar 1973;83(3):347-54. [Medline].

  12. Mu L, He P, Sun D. Inhalation of foreign bodies in Chinese children: a review of 400 cases. Laryngoscope. Jun 1991;101(6 Pt 1):657-60. [Medline].

  13. Svedstrom E, Puhakka H, Kero P. How accurate is chest radiography in the diagnosis of tracheobronchial foreign bodies in children?. Pediatr Radiol. 1989;19(8):520-2. [Medline].

  14. Tang FL, Chen MZ, Du ZL, Zou CC, Zhao YZ. Fibrobronchoscopic treatment of foreign body aspiration in children: an experience of 5 years in Hangzhou City, China. J Pediatr Surg. Jan 2006;41(1):e1-5. [Medline].

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Further Reading

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Keywords

foreign body aspiration, choking, foreign body esophagus, aspiration of foreign bodies, airway foreign body, tracheal obstruction, asphyxiation, occlusion of the airway, hypoxic brain damage, lung abscess, focal bronchiectasis, hemoptysis, croup, lung abscess, pneumonia, focal bronchiectasis, diagnosis, treatment

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Contributor Information and Disclosures

Author

Michael R Bye, MD, Professor of Clinical Pediatrics, Division of Pulmonary Medicine, Columbia University College of Physicians and Surgeons; Attending Physician, Pediatric Pulmonary Medicine, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University Medical Center
Michael R Bye, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, and American Thoracic Society
Disclosure: Merck Honoraria Speaking and teaching

Medical Editor

Thomas Scanlin, MD, Chief, Division of Pediatric Pulmonary & Cystic Fibrosis, Assistant Professor, Department of Pediatrics, Robert Wood Johnson University Medical Group
Thomas Scanlin, MD is a member of the following medical societies: American Thoracic Society and Society for Pediatric Research
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Charles Callahan, DO, Professor, Deputy Chief of Clinical Services, Walter Reed Army Medical Center
Charles Callahan, DO is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, American College of Osteopathic Pediatricians, American Thoracic Society, Association of Military Surgeons of the US, and Christian Medical & Dental Society
Disclosure: Nothing to disclose.

CME Editor

Mary E Cataletto, MD, Associate Director, Division of Pediatric Pulmonology, Winthrop University Hospital; Professor of Clinical Pediatrics, State University of New York at Stony Brook; Director of Children's Sleep Services, Winthrop University Hospital
Mary E Cataletto, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Chest Physicians
Disclosure: Shering Plough Pharmaceuticals Honoraria Consulting

Chief Editor

Michael R Bye, MD, Professor of Clinical Pediatrics, Division of Pulmonary Medicine, Columbia University College of Physicians and Surgeons; Attending Physician, Pediatric Pulmonary Medicine, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University Medical Center
Michael R Bye, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, and American Thoracic Society
Disclosure: Merck Honoraria Speaking and teaching

 
 
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