Airway obstruction

Blockage in the respiratory system

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Medical condition

Airway obstruction

Specialty| Pulmonology
Upper and lower airway

Airway obstruction is a blockage of respiration in the airway that hinders the free flow of air. Airway obstructions can occur either in the upper airway or lower airway. The upper airway consists of the nose, throat, and larynx. The lower airway comprises the trachea, bronchi, and bronchioles.[1][page needed]

Airway obstruction is a life-threatening condition and requires urgent attention.[2]

## Upper airway obstruction

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Further information: Choking

### Causes

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The causes of upper airway obstructions can be acute or chronic. Acute causes of upper airway obstruction include foreign body aspiration, blunt trauma to the neck, infection, and swelling due to allergies or other inflammatory conditions.[3] In children, viral infections such as croup or epiglottitis are frequent causes.[4] Adults are more likely to experience obstruction from enlargement of the tonsils or vocal cord paralysis.[3] Obstructive sleep apnea is the most common chronic cause of upper airway obstruction.[2]

### Symptoms

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Stridor is a high-pitched sound which occurs during breathing and is associated with obstruction at the level of the larynx. Difficulty swallowing and changes in voice are common symptoms.[3] If there is total obstruction, severe respiratory distress or cyanosis due to hypoxia (lack of oxygen in the blood) can occur.[2]

### Diagnosis

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Diagram of bronchoscopy

With acute upper airway obstruction, respiratory distress can rapidly lead to respiratory failure without appropriate management[2] necessitating urgent and comprehensive assessment of ABCs (airway, breathing, and circulation).[1]

Imaging studies, including x-rays and CT scans, can aid diagnosis and quickly assess the obstruction's extent.[2] For children, ultrasound or MRI are preferred as they do not involve radiation.[5] Flexible laryngoscopy or bronchoscopy can directly visualize the airway.[2]

### Management

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Treatment depends on how severe the patient's condition is and the cause of the obstruction. If the patient is choking on a foreign body, the Heimlich maneuver can be used. More invasive methods, such as intubation, may be necessary to secure the airway. In severe cases, intubation may be difficult and a cricothyrotomy or tracheostomy may be necessary.[2][6]

Infections typically cause obstruction by swelling and are usually treated with antibiotics or corticosteroids to reduce inflammation.[1] For causes like tumors or abscesses, surgical removal may be required.[2]

### Prognosis

[edit]

With prompt treatment, outcomes are usually favorable. This is especially true for reversible conditions, like foreign body aspiration.[2] Chronic conditions, like vocal cord paralysis and sleep apnea,[7] may need ongoing care. If managed well, they usually have good outcomes.

### Complications

[edit]

Untreated or prolonged upper airway obstruction can cause severe, life-threatening complications.

* Hypoxia: Low blood oxygen can cause confusion and unconsciousness. It can also lead to cardiac arrest if not treated.[1][page needed]
* Aspiration pneumonia: Particles entering the lungs can cause infections.[8]
* Structural changes: Repeating obstruction or trauma may scar or narrow the upper airway. This is called subglottic or tracheal stenosis.[9][page needed]
* Voice changes: Chronic damage to the vocal cords may cause permanent voice changes or loss.[1][page needed]
* Cardiac arrest: Severe obstruction can cause asphyxiation, leading to heart failure if untreated.[8][page needed]

## Lower airway obstruction

[edit]

Further information: Obstructive lung disease

### Causes

[edit]

Figure A shows the location of the lungs and airways in the body. The inset image shows a detailed cross-section of the bronchioles and alveoli. Figure B shows lungs damaged by COPD. The inset image shows a detailed cross-section of the damaged bronchioles and alveolar walls.

Lower airway obstruction is mainly caused by increased resistance in the bronchioles, usually due to a decreased radius of the bronchioles. This typically occurs due to constriction and inflammation of the bronchioles that reduces the air inhaled in each breath. This restriction is worsened by mucus production and airway remodeling in chronic conditions.[1][page needed] Diseases that cause lower airway obstruction are called obstructive lung diseases.[10] Examples include chronic obstructive pulmonary disease (COPD), asthma, and bronchitis.[11]

### Symptoms

[edit]

Patients often experience wheezing, shortness of breath, and a chronic cough. A wheeze is a coarse, whistling sound in the airways during breathing. Worsening symptoms may include increased mucus production and reduced exercise tolerance.[11]

### Diagnosis

[edit]

Spirometry that measures the FEV1/FVC ratio, is the gold standard for diagnosing lower airway obstruction. A decreased ratio indicates obstruction.[12]

Chest X-rays can help exclude alternative diagnoses or include other comorbidities. CT images can provide more insight into any possible structural abnormalities.[11]

### Management

[edit]

Treatment of lower airway obstruction includes:

* Bronchodilators help relax and widen the airways, which improve the airflow.
* Inhaled corticosteroids can help decrease airway inflammation.[11]
* Long-term oxygen therapy is usually reserved for more severe chronic cases.[9][page needed]

Severe cases may need hospitalization and mechanical ventilation to help support breathing by keeping the airways open.[9][page needed]

### Outcomes

[edit]

Prognosis depends on the severity and cause of the obstruction. With early diagnosis and treatment, conditions like asthma often have a good outcome. But, chronic diseases like COPD are progressive, requiring ongoing management.[11]

### Complications

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Complications of lower airway obstruction, often from chronic diseases, include:

* Chronic hypoxia: Prolonged obstruction reduces oxygen supply. This leads to fatigue, confusion, and eventual organ damage.[1][page needed]
* Cor Pulmonale: Persistent low oxygen levels can strain the right side of the heart. This can lead to right-sided heart failure.[9][page needed]
* Frequent infections: There is an increase risk of bacterial infections like pneumonia.[1][page needed]

## See also

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* Recurrent airway obstruction

## References

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1. ^ a b c d e f g h Loscalzo, Joseph; Fauci, Anthony; Kasper, Dennis; Hauser, Stephen; Longo, Dan; Jameson, Larry (2022). Harrison's Principles of Internal Medicine (21 ed.). McGraw Hill Education.
2. ^ a b c d e f g h i Aboussouan, L.S.; Stoller, J.K (15 March 1994). "Diagnosis and management of upper airway obstruction". Clinics in Chest Medicine. 15 (1): 35–53\. doi:10.1016/S0272-5231(21)01054-6. PMID 8200192. Archived from the original on 25 June 2021. Retrieved 25 June 2021.
3. ^ a b c O Cathain, Eadaoin; Gaffey, Megan M. (2024), "Upper Airway Obstruction", StatPearls, Treasure Island (FL): StatPearls Publishing, PMID 33232069, retrieved 2024-10-31
4. ^ Johnson, David Wyatt (2014-09-29). "Croup". BMJ Clinical Evidence. 2014: 0321. ISSN 1752-8526. PMC 4178284. PMID 25263284.
5. ^ Ohana, Orly; Soffer, Shelly; Zimlichman, Eyal; Klang, Eyal (2018-05-01). "Overuse of CT and MRI in paediatric emergency departments". The British Journal of Radiology. 91 (1085). doi:10.1259/bjr.20170434. ISSN 0007-1285. PMC 6190788. PMID 29271231.
6. ^ Apfelbaum, Jeffrey L.; Hagberg, Carin A.; Connis, Richard T.; Abdelmalak, Basem B.; Agarkar, Madhulika; Dutton, Richard P.; Fiadjoe, John E.; Greif, Robert; Klock, P. Allan; Mercier, David; Myatra, Sheila N.; O’Sullivan, Ellen P.; Rosenblatt, William H.; Sorbello, Massimiliano; Tung, Avery (2021-11-11). "2022 American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway". Anesthesiology. 136 (1): 31–81\. doi:10.1097/aln.0000000000004002. ISSN 0003-3022. PMID 34762729.
7. ^ Patil, Susheel P.; Ayappa, Indu A.; Caples, Sean M.; Kimoff, R. John; Patel, Sanjay R.; Harrod, Christopher G. (2019-02-15). "Treatment of Adult Obstructive Sleep Apnea With Positive Airway Pressure: An American Academy of Sleep Medicine Systematic Review, Meta-Analysis, and GRADE Assessment". Journal of Clinical Sleep Medicine. 15 (2): 301–334\. doi:10.5664/jcsm.7638. ISSN 1550-9389. PMC 6374080. PMID 30736888.
8. ^ a b Gropper, Michael A., ed. (2020). Miller's anesthesia (Ninth ed.). Philadelphia, PA: Elsevier. ISBN 978-0-323-59604-6.
9. ^ a b c d Goldman, Lee; Schafer, Andrew (2022). Goldman-Cecil Medicine (26th ed.). Elsevier. ISBN 9789752779259.
10. ^ "Airway Obstruction". The Lecturio Medical Concept Library. Archived from the original on 2021-06-25. Retrieved 2021-06-25.
11. ^ a b c d e "2024 GOLD Report". Global Initiative for Chronic Obstructive Lung Disease - GOLD. Retrieved 2024-11-08.
12. ^ Balata, Haval; Harvey, Jonathan; Barber, Phil V; Colligan, Denis; Duerden, Rebecca; Elton, Peter; Evison, Matthew; Greaves, Melanie; Howells, John; Irion, Klaus; Karunaratne, Devinda (15 Jul 2020). "Spirometry performed as part of the Manchester community-based lung cancer screening programme detects a high prevalence of airflow obstruction in individuals without a prior diagnosis of COPD". Thorax. 75 (8): 655–660\. doi:10.1136/thoraxjnl-2019-213584. ISSN 0040-6376. PMID 32444437. S2CID 218855570.

## External links

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Classification|

* MeSH: D000402

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* v
* t
* e

Diseases of the respiratory system

Upper RT
(including URTIs,
common cold)|

| Head|

sinuses

Sinusitis

nose

Rhinitis

Vasomotor rhinitis
Atrophic rhinitis
Hay fever
Nasal polyp
Rhinorrhea
nasal septum

Nasal septum deviation
Nasal septum perforation
Nasal septal hematoma

tonsil

Tonsillitis
Adenoid hypertrophy
Peritonsillar abscess

|

Neck|

pharynx

Pharyngitis

Strep throat
Laryngopharyngeal reflux (LPR)
Retropharyngeal abscess

larynx

Croup
Laryngomalacia
Laryngeal cyst
Laryngitis
Laryngopharyngeal reflux (LPR)
Laryngospasm

vocal cords

Laryngopharyngeal reflux (LPR)
Vocal fold nodule
Vocal fold paresis
Vocal cord dysfunction

epiglottis

Epiglottitis

trachea

Tracheitis
Laryngotracheal stenosis

Lower RT/
lung disease
(including LRTIs)|

| Bronchial/
obstructive|

acute

Acute bronchitis

chronic

COPD

Chronic bronchitis
Acute exacerbation of COPD)
Asthma (Status asthmaticus
AERD
Exercise-induced
Bronchiectasis
Cystic fibrosis

unspecified

Bronchitis
Bronchiolitis

Bronchiolitis obliterans
Diffuse panbronchiolitis

|

Interstitial/
restrictive
(fibrosis)|

| External agents/
occupational
lung disease|

Pneumoconiosis

Aluminosis
Asbestosis
Baritosis
Bauxite fibrosis
Berylliosis
Caplan's syndrome
Chalicosis
Coalworker's pneumoconiosis
Siderosis
Silicosis
Talcosis
Byssinosis

Hypersensitivity pneumonitis

Bagassosis
Bird fancier's lung
Farmer's lung
Lycoperdonosis

|

Other|

* ARDS
* Combined pulmonary fibrosis and emphysema
* Pulmonary edema
* Löffler's syndrome/Eosinophilic pneumonia
* Respiratory hypersensitivity
* Allergic bronchopulmonary aspergillosis
* Hamman–Rich syndrome
* Idiopathic pulmonary fibrosis
* Sarcoidosis
* Vaping-associated pulmonary injury

Obstructive /
Restrictive|

| Pneumonia/
pneumonitis|

| By pathogen|

* Viral
* Bacterial
* Pneumococcal
* Klebsiella
* Atypical bacterial
* Mycoplasma
* Legionnaires' disease
* Chlamydiae
* Fungal
* Pneumocystis
* Parasitic
* noninfectious
* Chemical/Mendelson's syndrome
* Aspiration/Lipid

|

By vector/route|

* Community-acquired
* Healthcare-associated
* Hospital-acquired

By distribution|

* Broncho-
* Lobar

IIP|

* UIP
* DIP
* BOOP-COP
* NSIP
* RB

Other|

* Atelectasis
* circulatory
* Pulmonary hypertension
* Pulmonary embolism
* Lung abscess

Pleural cavity/
mediastinum|

| Pleural disease|

* Pleuritis/pleurisy

* Pneumothorax/Hemopneumothorax

Pleural effusion

Hemothorax
Hydrothorax
Chylothorax
Empyema/pyothorax
Malignant

Fibrothorax

|

Mediastinal disease|

* Mediastinitis
* Mediastinal emphysema

Other/general|

* Respiratory failure
* Influenza
* Common cold
* SARS
* COVID-19
* Idiopathic pulmonary haemosiderosis
* Pulmonary alveolar proteinosis

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