Upper airway obstructions affect the trachea, pharynx, or larynx. Though partial obstructions can be painful, complete obstructions can be life-threatening. Without treatment, they can quickly prove fatal.
Even with treatment, oxygen deprivation from airway obstructions can cause severe long-term morbidity, so these obstructions demand prompt treatment. Identifying the type and cause of airway obstruction may help correctly treat the problem.
Infectious Airway Obstructions
Many infections can obstruct the upper airway. Minor infections such as strep throat or dental abscesses can spread or trigger obstructive swelling. More frequently, these conditions endanger the upper airway:
- Abscesses, such as peritonsillar abscesses and retropharyngeal abscesses
- Epiglottitis
People with infectious airway obstructions usually seem very ill and may experience a fever or swelling. They may complain of a history of airway difficulties or a recent illness.
Upper Airway Obstruction from Burns
Burns can so severely damage the upper airway that it either collapses or swells to the point of obstruction. Though smoke inhalation is a common culprit, and the signs of this are usually immediately evident, it is also important to consider chemical burns. Ask about recent exposures, workplace conditions, and in the case of children and elders, potential household exposure to toxic chemicals.
Airway Obstructions from Foreign Objects
Foreign objects are a leading cause of upper airway obstruction, particularly in children under the age of five. Be sure to visually inspect the airway for signs of obstruction, even if caregivers say there has not been recent exposure to a choking hazard.
The airway also can become obstructed by loose dental structures, such as broken teeth or dentures. Ask about dental history and look for signs of broken or damaged teeth.
Anaphylaxis
Anaphylaxis rapidly closes the airway, usually in response to an allergen. There may be other symptoms, such as a rash, gastrointestinal symptoms, or changes in consciousness. Though anaphylactic allergies usually develop in childhood, it is possible for them to appear anytime—even in response to a substance a person has previously consumed without problems. Ask about recent food intake and new medications.
Traumatic Injuries
Traumatic injuries, such as from an auto accident, a blow to the face or throat, or from losing consciousness can fully or partially obstruct the upper airway. Spinal cord and head injuries may also interfere with the ability to voluntarily breathe even in a person who has no airway injuries, so be mindful of how neurological injuries may impact breathing.
Chronic and Progressive Illnesses
A handful of chronic and progressive conditions may obstruct the upper airway. Notably, advanced throat cancer may cause inflammation that makes breathing difficult.
People with asthma may experience asthma attack-related obstructions. In severe cases, these attacks can be life-threatening, so it’s important to intervene quickly if inhaled corticosteroids or other less invasive remedies fail.
Conditions that weaken the upper airway may also cause airway obstructions. Tracheomalacia, for example, is a weakness of the windpipe, sometimes due to congenital abnormalities but often following surgery or an injury. People with dementia are also vulnerable to upper airway weakness, often due to dysphagia.
The Importance of a Rapid Response
Upper airway obstruction is potentially a life-threatening emergency. Particularly in the event of a full obstruction due to choking or anaphylaxis, every second counts. Brain damage can occur in just a few minutes, and there is rarely time to transport the patient, or even move them elsewhere within the hospital.
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Editor's Note: This blog was originally published in March 2021. It has been re-published with additional up-to-date content.
