The clinical features of foreign body aspiration into the lower airway in geriatric patients

Abstract

PurposeTo analyze the clinical features of foreign-body aspiration into the lower airway in geriatric patients.Patients and methodsThe clinical data of 17 geriatric patients with foreign-body aspiration were retrospectively analyzed and compared with 26 nongeriatric adult patients. The data were collected from Peking University First Hospital and Anhui Chest Hospital between January 2000 and June 2014.Results(1) In the geriatric group, the most common symptoms were cough and sputum (15 cases, 88%), dyspnea (six cases, 35%), and hemoptysis (four cases, 24%). Five patients (29%) in the geriatric group could supply the history of aspiration on their first visit to doctor, a smaller percentage than in the nongeriatric group (13 cases, 50%). Only three cases in the geriatric group were diagnosed definitely without delay. Another 14 cases were misdiagnosed as pneumonia or lung cancer, and the time of delayed diagnosis ranged from 1 month to 3 years. Complications due to delay in diagnosis included obstructive pneumonitis, atelectasis, lung abscess, and pleural effusion. (2) Chest computed tomography demonstrated the foreign body in three cases (21%) in the geriatric group, which was lower than the positive proportion of detection in the nongeriatric group (nine cases, 35%). The most common type of foreign body in the geriatric group was food, such as bone fragments (seven cases, 41%) and plants (seven cases, 41%), and the foreign body was most often lodged in the right bronchus tree (eleven cases, 65%), especially the right lower bronchus (seven cases, 41%). Flexible bronchoscopy removed the foreign body successfully in all patients.ConclusionThe clinical features of foreign-body aspiration in geriatric patients are usually more obscure than in nongeriatric adults, which may lead to long delay in diagnosis. Flexible bronchoscopy is safe and useful for early diagnosis and effective management in geriatric patients. We suggest flexible bronchoscopy as the first-line approach to similar patients, especially those with aspiration history and unexplained pneumonia.

A Case of Chronic Cough and Pneumonia Secondary to a Foreign Body

“…Predisposing factors are frequently associated with foreign body aspiration in adults, particularly, altered mental status, neuromuscular disease, head trauma, and psychiatric disorders [1]. Impaired cough reflex and dysphagia contribute to the pathology of aspiration [2]. Foreign bodies may result in serious complications if left undiagnosed.…”

“…Endobronchial foreign body is one of the suspected causes of persistent obstructive pneumonia [4]. Signs and symptoms are nonspecific which include cough, shortness of breath, wheezing, and/or hemoptysis [2]. …”

“…Signs of atelectasis and/or chronic or recurrent infiltrate in chest imaging may raise suspicion for an endobronchial lesion or foreign body. However, a normal chest radiograph is not uncommonly seen [2]. Therefore, a high index of clinical suspicion is at times necessary to make the diagnosis, regardless of an unremarkable chest radiograph.…”

“…Gustav Killian performed the first bronchoscopy in 1897 to diagnose, evaluate, and treat foreign body aspiration [2]. Since then, bronchoscopy has been the gold standard in diagnosing foreign body aspiration in adults.…”

Foreign Bodies of Trachea and Bronchi

“…Поздняя диагностика и лечение пациентов с инородными телами дыхательных путей (ИТДП) может привести к развитию тяжелых осложнений и летальным исходам [4, 5,6]. Согласно данным большинства авторов, при случайной аспирации различных инородных тел в более чем 70% случаев они застревают в области бронхов [7,8,9,10]. Удаление ИТДП является сложной задачей и зависит как от типа инородного тела, его локализации, оснащенности клиники, так и от опыта врача [1][2][3][4][5][6][7][8][9][10][11][12][13][14].…”