Coughing can sometimes be a sign of aspiration, which occurs when food, liquid, or saliva enters the airways instead of being swallowed into the esophagus. However, coughing does not always mean aspiration has occurred. Here is an overview of the connection between coughing and aspiration.
What is aspiration?
Aspiration happens when materials like food, liquid, or saliva get past the vocal cords and enter the windpipe (trachea) and lungs instead of being swallowed into the esophagus and stomach. This can occur in people of all ages, but is more common in the very young and very old.
There are two main types of aspiration:
- Silent aspiration – no coughing or outward signs
- Overt aspiration – coughing or choking occurs
Silent aspiration is more dangerous because the person does not show signs. Overt aspiration usually causes coughing which may help clear some aspirated material from the airway.
What causes aspiration?
Some common causes of aspiration include:
- Dysphagia – swallowing disorders, usually in stroke or progressive illness like Parkinson’s
- Gastroesophageal reflux disease (GERD) – contents from stomach backwash into esophagus and sometimes airway
- Physical obstruction – mass or object obstructing the airway
- Compromised gag reflex from medications, alcohol intoxication, neurological issues
- Mechanical ventilation – intubated patients
- Impaired consciousness from anesthesia, drug overdose, seizures
- Neuromuscular disorders – like ALS, myasthenia gravis, multiple sclerosis
Why might coughing occur with aspiration?
Coughing is a protective reflex the body uses to keep the airway clear. When food, liquid, or other particles enter the windpipe instead of the esophagus, the lining of the airway becomes irritated. This triggers cough receptors which send signals to the brain to cough. Coughing helps expel some of the aspirated material to keep the airway open.
When does coughing indicate aspiration has occurred?
Coughing during or immediately after eating or drinking may indicate aspiration has occurred. Some signs coughing is linked to aspiration include:
- Coughing that begins during or right after swallowing food or liquid
- Choking immediately before coughing
- Wet-sounding cough
- Difficulty controlling cough or stopping coughing episodes
- Food/liquid coming out the mouth or nose when coughing
- Fever or pneumonia-like symptoms following coughing episode
However, sometimes coughing associated with aspiration can be subtle and not with every swallow. People may occasionally cough when eating or drinking without aspirating. Chronic aspiration can cause repeated bouts of pneumonia.
When might coughing NOT indicate aspiration?
While coughing can accompany aspiration, there are also many instances when coughing has nothing to do with aspiration. Some examples include:
- Cough due to allergies or asthma
- Cough from postnasal drip
- Dry cough from infection, smoking, or environmental irritants
- Cough triggered by medications like ACE-inhibitors
- Cough that begins long after eating or drinking
- Cough absent during swallowing, only occurring later
So while coughing during or shortly after swallowing may raise suspicion for aspiration, coughing can occur commonly for reasons unrelated to aspiration.
What are risks associated with aspiration?
Aspiration can lead to serious health complications, especially if it occurs repeatedly. Risks include:
- Choking – Large particles can obstruct the airway
- Pneumonia – Bacteria enter the lungs leading to infection
- Lung abscesses – Walled off areas of infection in the lung
- Acute respiratory distress syndrome (ARDS) – Severe lung inflammation
- Sepsis – Blood infection spreading to other organs
- Bronchiectasis – Permanent lung damage
- Respiratory failure
- Death in severe cases
How can aspiration be prevented and treated?
If aspiration is suspected, a doctor can perform tests to evaluate swallowing and look for signs of aspiration. Ways to manage aspiration include:
- Swallowing therapy – Exercises to strengthen muscles used for swallowing
- Diet modification – Adjusting food/liquid textures to make swallowing easier
- Feeding tube – For severe dysphagia patients to provide nutrition
- Medications – Treating reflux and reducing excessive secretions
- Surgery – For some obstructions causing aspiration
- Suctioning – Removing excess secretions from the airway
- Antibiotics – If infection occurs in the lungs
- Avoiding smoking, alcohol, and sedatives – Which can increase aspiration risk
Proper oral care is also important to reduce bacteria in saliva that could lead to pneumonia if aspirated. Positioning someone upright, advocating for a safe swallowing environment, and closely monitoring meals can help prevent episodes of aspiration.
Conclusion
Coughing during or after swallowing can be an indication of aspiration, where food or liquid enters the airway. However, coughing can also be caused by many other conditions unrelated to aspiration. Tests like endoscopy, chest x-rays, or swallowing evaluations may be needed to confirm if aspiration is the cause. Preventative strategies, dietary changes, and sometimes medical interventions can help manage aspiration to avoid serious complications like pneumonia, lung damage, and respiratory failure.